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 2026, 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 Select Counties in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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:
Sign up for Anthem Medicare Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual drug deductible of $250. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail order, though standard pharmacies charge a $10 copay for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 30% coinsurance at preferred, standard, and standard mail-order pharmacies. These coinsurance rates apply to all available supply durations, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, urgent care, and partial hospitalization require modest copays ranging from $40 to $45 with no coinsurance. For inpatient hospital stays, members pay a daily copay of $450 for the first five days, after which there is no copay. Routine dental, vision, and hearing exams are covered with no copay, though comprehensive dental services are excluded from coverage. Prescription hearing aids and routine eyewear are covered with no copay up to specified annual limits, while diabetic supplies also feature no copay or coinsurance. Other services, such as diagnostic lab tests and home infusion, require no copay, whereas dialysis and durable medical equipment involve up to a 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) inpatient hospital benefits are partially covered with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Covered acute stays require a $450 copay per day for days 1 through 5 (with no copay for days 6 and beyond), while psychiatric stays require a $450 copay per day for days 1 through 4 and no copay for additional days.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) outpatient services are covered with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Anthem Medicare Advantage (HMO-POS) plan, with ground and air ambulance services requiring prior authorization and a $280 copay with no coinsurance. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) provides primary care physician and telehealth services with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $45 copay and no coinsurance. Physical and occupational therapy services have a $35 copay and no coinsurance, podiatry ranges from no copay to a $45 copay with no coinsurance, and chiropractic services are not covered in practice.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. This benefit is partially covered, as supplemental services such as fitness benefits, health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services, featuring Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit—excluding inner, outer, and over-the-ear types—while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) covers vision services with no coinsurance or deductibles, featuring one routine eye exam annually with no copay, though other eye exam services are not covered. Covered eyewear, including contact lenses and eyeglasses, has no copay up to a $300 annual maximum, but upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered dental services with no copay and no coinsurance for Medicare-covered dental care, cleanings, oral exams, fluoride treatments, and dental x-rays. However, other diagnostic dental services and all comprehensive treatments—including restorative, endodontic, periodontic, prosthodontic, and orthodontic services—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment and supplies are covered with no copay and no coinsurance, though prior authorization and vendor limitations may apply to certain items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage (HMO-POS) with prior authorization, offering lab services with no copay or coinsurance and diagnostic procedures with no coinsurance and copays ranging from no copay up to $175. Diagnostic radiological services require a minimum $50 copay with no coinsurance, outpatient X-rays require a $50 copay with coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Anthem Medicare Advantage (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance and prior authorization required, but in practice, some services are covered while cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved