A non-government entity
Anthem Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (HMO). 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) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (HMO) 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).
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), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. 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 $380.00 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 $6800.00 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) plan has a $380 deductible for prescription drugs. Once you meet the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will have no copay for preferred generic drugs at a preferred pharmacy and a 20% coinsurance for standard generic drugs. In the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO) plan offers a variety of benefits, including inpatient hospital stays with a $440 copay for the first four days, and no copay thereafter. Outpatient services have varying cost-sharing, with some services like outpatient blood services and preventive services like annual physical exams with no copay. Primary care visits have a $20 copay, and emergency services have a $110 copay. The plan also covers vision services with no copay for routine eye exams, but does not cover some dental services. Hearing services are partially covered, and home health services are covered with no copay. Diagnostic and radiological services have varying copays and coinsurance, while ambulance services have a copay depending on the type of service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $440 copay for days 1-4, and no copay for days 5-90. Additional days for both are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a 30% coinsurance and no copay, observation services with a 30% coinsurance and no copay, and ambulatory surgical center (ASC) services with a 20% coinsurance and no copay. Outpatient substance abuse services, including individual and group sessions, have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance. 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 by the Anthem Medicare Advantage (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $45 copay, and there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services have a $20 copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $35 copay, Physician Specialist Services have a $50 copay, Individual and Group Sessions for Mental Health Specialty Services each have a $40 copay, Other Health Care Professional services have a $20 copay, Individual and Group Sessions for Psychiatric Services each have a $40 copay, Physical Therapy and Speech-Language Pathology Services have a $40 copay, Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Annual Physical Exams with no copay. Additionally, this plan covers several other preventive services, including Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services are partially covered by Anthem Medicare Advantage (HMO), with a $50 copay for Hearing Exams. However, Routine Hearing Exams, Fitting/Evaluation for Hearing Aids, Prescription Hearing Aids (all types), Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0, and eyewear. Eyewear benefits include contact lenses with no copay, while eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Anthem Medicare Advantage (HMO) plan. Medicare Dental Services are covered with no copay, but other services such as Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, and 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 under the Anthem Medicare Advantage (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $40 and $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Medicare Advantage (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered by the Anthem Medicare Advantage (HMO) plan. Some services under this benefit that are not covered include acupuncture, over-the-counter items, and meal benefits.
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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.
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