A non-government entity
Anthem Medicare Advantage 3 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 3 (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 3 (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 3 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Suffolk County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 3 (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 3 (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 3 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $70.00. 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 $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:
Sign up for Anthem Medicare Advantage 3 (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage 3 (HMO-POS) plan features an annual drug deductible of $275. Tier 1 preferred generic drugs have no copay at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs also have no copay at preferred pharmacies and standard mail order, though purchasing them at standard pharmacies requires a copay of $10 for a one-month supply, $20 for a two-month supply, or $30 for a three-month supply. For brand-name and specialty medications, your costs will be based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance at preferred, standard, and standard mail-order pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply across all available pharmacy networks.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers comprehensive medical coverage featuring no copay or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, copays range up to $50 with no coinsurance, while emergency room visits require a $115 copay. Inpatient hospital stays require a daily copay of $410 for the first few days followed by no copay for additional days, while outpatient hospital services carry a 25% coinsurance. This plan also includes valuable routine care benefits to help lower your out-of-pocket costs. You will pay no copay or coinsurance for routine dental cleanings, annual eye exams, and routine hearing tests, alongside allowances of up to $2,000 for prescription hearing aids and $200 for eyewear. Additionally, the plan provides a quarterly allowance of $45 with no copay or coinsurance for over-the-counter health items.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $410 daily copay for days 1 to 5 of an acute stay and days 1 to 4 of a psychiatric stay, followed by no copay for additional days. Prior authorization is required for these services, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers outpatient hospital services with a 25% coinsurance and no copay, and ambulatory surgical center services with a 20% coinsurance and no copay. Outpatient substance abuse services require a $50 copayment per session with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Anthem Medicare Advantage 3 (HMO-POS) plan, with a $325 copay and no coinsurance for both ground and air ambulance services. Although some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Anthem Medicare Advantage 3 (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 limit of $100,000.
Primary Care See details
Anthem Medicare Advantage 3 (HMO-POS) covers primary care physician services and telehealth benefits with no copay and no coinsurance. Other covered benefits, such as specialist visits, therapy services, and mental health care, have copays ranging from $0 to $50 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding services like health education, personal emergency response systems (PERS), nutritional training, alternative therapies, and in-home support.
Hearing Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, alongside annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, excluding inner ear, outer ear, and over the ear types. Over-the-counter (OTC) hearing aids are also covered up to $300 per year with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, featuring no copay for one routine eye exam per year and no copay for covered eyewear up to a $200 annual limit. Other eye exam services and eyewear upgrades are not covered, and some eye exams may require prior authorization and a copay of up to $50.
Dental Services See details
Anthem Medicare Advantage 3 (HMO-POS) provides partial dental coverage with no copay and no coinsurance for covered services, which include annual exams, cleanings, X-rays, fluoride, and Medicare-covered dental. Non-covered services include other diagnostic or preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Medicare Advantage 3 (HMO-POS) with no copays for all services. Durable medical equipment features a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests and lab services have no coinsurance, with lab services requiring no copay and diagnostic tests carrying copays up to $150. Radiological services require copays starting at $40 for x-rays and diagnostic scans, or a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required and some services are not covered. Specifically, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required and a prior three-day inpatient hospital stay is not needed, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 3 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $45 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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