A non-government entity
Anthem Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Nassau County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 2 (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 2 (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 2 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $56.00. 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 $275.00 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 $8300.00 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 2 (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage 2 (HMO-POS) plan features a $275 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies at preferred pharmacies, standard pharmacies, and standard mail order. For Tier 2 generic drugs, you will pay no copay at preferred pharmacies or standard mail order, while standard pharmacies charge a copay ranging from $5 to $15 depending on the supply length. Higher-tier medications require coinsurance rather than flat copays during the initial coverage phase. Tier 3 preferred brand drugs carry a 25% coinsurance, and Tier 4 non-preferred drugs require a 30% coinsurance across preferred, standard, and mail-order options. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers affordable medical coverage with no copay for primary care, telehealth, and routine preventive services. For inpatient hospital stays, members pay a $400 daily copay for the first five to six days and no copay for additional days. Emergency room visits require a $115 copay, while specialist visits have a copay between $35 and $50 with no coinsurance. Routine dental, vision, and hearing exams are covered with no copay, and the plan provides allowances for both hearing aids and eyewear. Home health services and cardiac rehabilitation are also covered with no copay or coinsurance. Additionally, durable medical equipment features no copays with coinsurance up to 20%, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1-6 of acute stays and days 1-5 of psychiatric stays, with no copay for additional days. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers outpatient hospital services with no copay and 25% coinsurance, observation services with 25% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse services require a $50 copay per session with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage 2 (HMO-POS) with a $40.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers ground and air ambulance services with a $325 copayment 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 2 (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 of $100,000.
Primary Care See details
Anthem Medicare Advantage 2 (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $35 to $50 with no coinsurance. Other healthcare professional services have a copay of up to $15 with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers Medicare-covered hearing exams for a $50 copay and no coinsurance, while routine annual exams and fitting evaluations have 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 models are not covered. OTC hearing aids are also covered with no copay or coinsurance up to $300 annually, and prior authorization is required for exams and hearing aids.
Vision Services See details
Vision Services are partially covered by Anthem Medicare Advantage 2 (HMO-POS) with no deductible and no coinsurance, featuring eye exams with a $0 to $50 copay and eyewear with no copay up to a $125 annual limit. One routine annual eye exam is covered with no copay, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage 2 (HMO-POS) offers partially covered dental services with no copay and no coinsurance for Medicare-covered dental care and preventive services, including annual oral exams, cleanings, dental x-rays, and fluoride. Comprehensive treatments such as restorative services, endodontics, periodontics, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance, though prior authorization and step therapy are required. Within 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 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Medicare Advantage 2 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (HMO-POS) covers medical equipment with no copays, including durable medical equipment (DME), prosthetics, and diabetic supplies. Coinsurance ranges from 0% to 20% for DME, is 20% for prosthetics and medical supplies, and there is no coinsurance for diabetic equipment.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers diagnostic procedures with no coinsurance and a $0 to $150 copay, while lab services are covered with no copay or coinsurance. Radiological services require prior authorization and include outpatient x-rays for a $45 copay, diagnostic radiology starting at a $45 copay, and therapeutic radiology with a 20% coinsurance.
Home Health Services See details
Anthem Medicare Advantage 2 (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 2 (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 2 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This benefit is partially covered, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 2 (HMO-POS) partially covers other services, providing a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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