A non-government entity
Anthem Extra Help (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Extra Help (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Extra Help (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Extra Help (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 Extra Help (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 Extra Help (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 Extra Help (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. 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 $390.00 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 $5900.00 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 Extra Help (HMO-POS)
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Drug Coverage
The Anthem Extra Help (HMO-POS) plan features an annual drug deductible of $390. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies. For other prescription tiers, costs are based on coinsurance rather than flat copayments. Tier 2 generic drugs, Tier 3 preferred brand drugs, and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Specialty drugs in Tier 5 carry a 28% coinsurance for a one-month supply.
Additional Benefits
The Anthem Extra Help (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for primary care visits, telehealth, and covered preventive care. Specialist visits, physical therapy, and mental health services require a $20 copay, while emergency room visits carry a $125 copay. Inpatient hospital stays require a $440 daily copay for the first five days, with no copay for day six and beyond. This plan also includes valuable supplemental benefits, including preventive dental care with no copay or coinsurance and comprehensive dental covered up to $2,250 annually with a 25% coinsurance. Members benefit from annual routine vision and hearing exams with no copay, alongside a $350 annual eyewear allowance and up to $3,000 for prescription hearing aids. Additionally, the plan provides a $95 quarterly allowance for over-the-counter items and up to 12 one-way transportation trips per year to approved locations with no copay.
Inpatient Hospital See details
Anthem Extra Help (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $440 daily copay for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Extra Help (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $440 for outpatient hospital services and a $440 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays or coinsurance, while outpatient substance abuse individual and group sessions require a $20 copay.
Partial Hospitalization See details
Anthem Extra Help (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Extra Help (HMO-POS) covers ambulance services with a $255 copay and no coinsurance for both ground and air transport, subject to prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Anthem Extra Help (HMO-POS) covers emergency services with a $125 copay and urgently needed services with a $25 copay, with no coinsurance required for either service. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $100,000 maximum limit with a $125 copay and no coinsurance.
Primary Care See details
Anthem Extra Help (HMO-POS) primary care and telehealth services are available with no copay and no coinsurance, while specialists, physical therapy, and mental health services require a $20 copay and no coinsurance. Podiatry and other healthcare professional services have copays ranging up to $20 with no coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Extra Help (HMO-POS) offers preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and remote access technologies. This benefit is partially covered, as fitness benefits, health education, counseling, telemonitoring, home and bathroom safety devices, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs for chemotherapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, and additional smoking cessation counseling are not covered.
Hearing Services See details
Anthem Extra Help (HMO-POS) covers hearing exams with a $20 copay for Medicare-covered exams and no copay for annual routine exams and fittings, all with no coinsurance or deductibles. Prescription hearing aids are partially covered up to $3,000 yearly with no copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models, while OTC hearing aids are covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Anthem Extra Help (HMO-POS) partially covers vision services with no deductibles or coinsurance, offering eye exams with a $0 to $20 copay and a $350 annual eyewear allowance with no copay. Routine eye exams are covered with no copay once per year, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Extra Help (HMO-POS) offers partially covered dental services with a $2,250 annual maximum, featuring no copay and no coinsurance for preventive care like cleanings and x-rays. Covered comprehensive dental services require no copay and 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Extra Help (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and clinical drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Extra Help (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Extra Help (HMO-POS) covers medical equipment with no copays, though coinsurance costs apply to certain items. Durable medical equipment has no copay and 0% to 20% coinsurance, prosthetic devices and medical supplies carry no copay and 20% coinsurance, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Extra Help (HMO-POS) covers diagnostic and radiological services, with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $175 copay for diagnostic procedures. Radiological services require a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Anthem Extra Help (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Extra Help (HMO-POS) covers cardiac rehabilitation services with no coinsurance and prior authorization, but some services are covered while others are not. Specifically, cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($35 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Anthem Extra Help (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Other Services are partially covered by Anthem Extra Help (HMO-POS) with no copay and no coinsurance, including a $95 quarterly over-the-counter item allowance, chronic illness meal benefits, and community resource support. Acupuncture is not covered under this plan benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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