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 2026, 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 2026 to people living in Select counties in CT. 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) 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 $63.00. 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 $215.00 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:
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Drug Coverage
The Anthem Medicare Advantage (HMO) plan features an annual prescription drug deductible of $215. Members can save on healthcare costs with no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at a preferred pharmacy or through standard mail order. Additionally, Tier 6 select care drugs are available with no copay at all participating pharmacy types. For higher-tier medications, Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance. Specialty drugs under Tier 5 also require a 30% coinsurance and are limited to a one-month supply. If you choose to use a standard retail pharmacy, Tier 1 and Tier 2 copays start at just $5 and $10 for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO) plan offers comprehensive coverage with affordable cost-sharing, featuring no copays or coinsurance for primary care visits, routine annual physicals, and home health services. Specialist visits require a 50 dollar copay, while inpatient hospital stays carry a 450 dollar daily copay for the first five days and no copay for additional days. Emergency room visits have a 115 dollar copay and urgent care services require a 40 dollar copay, both with no coinsurance. For additional care, the plan features routine vision and hearing exams with no copay, alongside annual allowances of up to 2,000 dollars for prescription hearing aids and 175 dollars for eyewear. While Medicare-covered dental care is covered with no copay, routine dental services are not covered under this plan. Durable medical equipment and dialysis services require no copay but carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, you pay a $450 daily copay for days 1 through 5 and no copay for additional days, whereas psychiatric stays require a $415 daily copay for days 1 through 5 and no copay thereafter. Non-Medicare-covered stays and acute upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copays. Outpatient hospital services require a $0 to $450 copay, observation services carry a $450 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Other services, including physical, occupational, psychiatric, and mental health therapies, are covered with copays between $35 and $40 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are only partially covered; remote access technologies have no copay and no coinsurance, but services like fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO) covers hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, and annual routine exams and evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, though inner ear, outer ear, and over the ear types are not covered, while over-the-counter hearing aids are covered with no copay or coinsurance up to $300 annually.
Vision Services See details
Anthem Medicare Advantage (HMO) features partially covered vision services with no deductibles and no coinsurance, offering a routine eye exam every year with no copay and up to $175 annually for eyewear with no copay. Other eye exam services and eyewear upgrades are not covered, and other covered eye exams may require a copay between $0 and $50.
Dental Services See details
Anthem Medicare Advantage (HMO) partially covers dental services, offering Medicare-covered dental care with no copay and no coinsurance, though prior authorization is required. Routine and comprehensive dental services, including exams, cleanings, x-rays, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Medicare Advantage (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under Anthem Medicare Advantage (HMO) feature no copays across all categories, though prior authorization is required for certain items. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is fully covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay between $0 and $70. Radiological services require prior authorization and feature a $25 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Anthem Medicare Advantage (HMO) with no copay and no coinsurance, though in practice some services are covered but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are not covered by Anthem Medicare Advantage (HMO), meaning there is no coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
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