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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 2025, 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 State of Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $15.60. 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 $590.00 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 Extra Help (HMO-POS) plan has a deductible of $590. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2,000. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $15.60.
Additional Benefits
The Anthem Extra Help (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $440. The plan also includes coverage for ambulance and transportation services, emergency services, and a variety of primary care services, many with no copay. Additional benefits include preventive services, hearing services with a $40 copay for exams and no copay for hearing aids (with a maximum coverage amount), and vision services with no copay for routine eye exams and eyewear. Dental services, home infusion, medical equipment, and diagnostic services are also covered, often with no copay or a coinsurance. Other services like OTC items and meals are covered with no copay, while some services, such as skilled nursing facility stays, have copays depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $440 for days 1-4, and no copay for days 5-90. Additional days for both Inpatient Hospital-Acute and Psychiatric 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, with copays ranging from $0 to $440, and observation services with a $440 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Extra Help (HMO-POS) plan, with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Anthem Extra Help (HMO-POS) plan covers ambulance and transportation services, including both ground and air ambulance services. Ground ambulance services have a copay of $290, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, with a limit of 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem Extra Help (HMO-POS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Extra Help (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay, and physician specialist services with a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have no copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Anthem Extra Help (HMO-POS) plan covers hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2,000 per year, and OTC hearing aids are covered with no copay up to a maximum of $300 per year. However, prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams have no copay. Eyewear has no copay, and a combined maximum benefit of $175 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay. Eyeglass frames are covered with no copay, but upgrades are not covered.
Dental Services See details
The Anthem Extra Help (HMO-POS) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, cleanings, fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics with no copay. This plan has a maximum benefit of $1,500 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Extra Help (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Extra Help (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Extra Help (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $110, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $440. Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Extra Help (HMO-POS) plan with no copay and no coinsurance. 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 Extra Help (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Extra Help (HMO-POS) 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with no copay, and a meal benefit with no copay; Acupuncture, 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. The OTC benefit has a maximum coverage amount of $35.00 every three months.
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