A non-government entity
Anthem Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Medicare Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Washoe County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Medicare Advantage (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Anthem Medicare Advantage (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, after you pay your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $7 copay for preferred generic drugs at a preferred pharmacy, or 20% coinsurance for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a range of benefits with varying costs. This plan provides coverage for inpatient hospital stays with copays, outpatient services, and emergency services. You'll also find coverage for primary care, preventive services, hearing, vision, and dental, with varying copays and maximum benefits for specific services. Additional benefits include ambulance services, prescription hearing aids, and durable medical equipment with associated costs. The plan also covers home health services, skilled nursing facility stays, and cardiac rehabilitation services. However, some services like private duty nursing and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $290 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $270 copay for days 1-6, and no copay for days 7-90. Additional days for both services are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $290, Observation Services have a copay of $290, and Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage (HMO-POS), with a $40 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $250 copay, air ambulance services with 20% coinsurance, and transportation services with no copay for plan-approved health-related locations (up to 60 one-way trips per year). Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay, with a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan offers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $40 copay. Mental health and psychiatric services are covered with a $40 copay for individual and group sessions, and other health care professional services are covered with a copay that ranges from $0 to $20. Additional telehealth benefits are covered with no copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, while other services like Health Education, In-Home Safety Assessment, and more are not covered. Additional preventive services, like fitness benefits, have a copay, while kidney disease education services and other preventive services like glaucoma screenings have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and OTC hearing aids have no copay with a maximum benefit of $300 per year for both ears combined. Prescription hearing aids are covered up to a maximum of $3,000 per year for both ears combined, while prescription hearing aids for the inner and outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including routine eye exams with a copay between $0 and $45, and eyewear such as contact lenses, eyeglasses, and eyeglass lenses and frames with no copay and a combined maximum benefit of $300 per year. Routine eye exams are limited to one per year.
Dental Services See details
The Anthem Medicare Advantage (HMO-POS) plan offers dental services with a $350 annual maximum. Preventive services, including oral exams, dental x-rays, and cleanings, have no copay, as do restorative services like fillings and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Anthem Medicare Advantage (HMO-POS) plan. Durable Medical Equipment (DME) has no copay, with a coinsurance between 0% and 20%, and requires authorization. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $60, and lab services with no copay. Outpatient X-ray services have a $5 copay, while diagnostic radiological services have a copay up to $300, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the specific services are covered. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan. There is no copay for days 1-20, and a $140 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Other 1, with no copay for OTC items. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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