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 Bronx Kings Queens New York Richmond. 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 $34.00. 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 $240.00 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 2 (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage 2 (HMO-POS) plan features an annual drug deductible of $240. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies, standard pharmacies, and through standard mail order. For Tier 2 generic drugs, there is also no copay when using a preferred pharmacy or standard mail order, though standard pharmacies charge a copay of $10 to $30 depending on the supply length. For brand-name and specialty medications, you will pay a percentage of the drug cost rather than a flat copay. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% coinsurance. These coinsurance rates apply across preferred pharmacies, standard pharmacies, and standard mail order, with Tier 5 specialty drugs limited to a one-month fill.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers robust coverage for essential medical needs, featuring no copay for primary care visits, telehealth services, and home health care. For specialized care, members pay a $50 copay for specialist visits and a $480 daily copay for the first four days of an inpatient hospital stay, with no copay for additional days. Emergency room services are covered with a $115 copay, while urgent care visits require a $40 copay. Preventive care and routine dental services, including cleanings and X-rays, are available with no copay or coinsurance. Members also benefit from one routine eye exam per year with no copay, though routine hearing exams require a $50 copay and eyewear and hearing aids are not covered. Additionally, the plan includes a $30 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Anthem Medicare Advantage 2 (HMO-POS) with no coinsurance and a daily copay of $480 for days 1 through 4, followed by no copay for days 5 and beyond for both acute and psychiatric stays. 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 services, featuring outpatient hospital care with no copay and 30% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse sessions require a $50 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Anthem Medicare Advantage 2 (HMO-POS) with a $325 copay and no coinsurance for both ground and air transport, which require prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Anthem Medicare Advantage 2 (HMO-POS) plan are covered with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and 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 for each service.
Primary Care See details
Anthem Medicare Advantage 2 (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance. Specialist visits, mental health, psychiatric, physical therapy, and opioid treatment services are covered with a $50 copay and no coinsurance, while occupational therapy has a $35 copay and chiropractic care is partially covered with a $15 copay (routine and other chiropractic services are not covered). Podiatry services are not covered, and prior authorization is required for most specialty and therapy services.
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, memory fitness, remote access, glaucoma screenings, and diabetes self-management. Services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers hearing exams with a $50 copay, no coinsurance, and no deductible, though prior authorization is required and routine exams and fitting evaluations are not covered. Some prescription hearing aid services are covered, but all types—including inner ear, outer ear, and over the ear—along with OTC hearing aids, are not covered.
Vision Services See details
Anthem Medicare Advantage 2 (HMO-POS) offers vision services where eye exams are partially covered with no copay and no coinsurance for one routine exam per year, but other eye exam services are not covered. For eyewear, some services are covered with no copay and no coinsurance, but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage 2 (HMO-POS), offering no copay and no coinsurance for Medicare-covered dental care, as well as routine exams, cleanings, fluoride, and X-rays. However, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, orthodontic, maxillofacial prosthetic, adjunctive general, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% (no coinsurance) to 20%.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage 2 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (HMO-POS) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage 2 (HMO-POS) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $150 copay for tests, while radiological services require a $55 copay for X-rays, a minimum $55 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Anthem Medicare Advantage 2 (HMO-POS) require prior authorization and have no coinsurance, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay) 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 and no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 2 (HMO-POS) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $30 every three months. Acupuncture, meal benefits, and other supplemental services under this category are not covered.
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