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 Rockland and Westchester Counties. 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 $30.00. 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 $230.00 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 $6750.00 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 2 (HMO-POS) plan features an annual prescription drug deductible of $230. For Tier 1 preferred generic drugs, you will pay no copay at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail-order, while standard pharmacies charge a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher-tier prescription drugs require coinsurance rather than flat copays under this plan. You will pay 25% coinsurance for Tier 3 preferred brand drugs and 30% coinsurance for Tier 4 non-preferred drugs at preferred, standard, and standard mail-order pharmacies. Tier 5 specialty drugs also require 30% coinsurance for a one-month supply across all available retail and mail-order pharmacy options.
Additional Benefits
Anthem Medicare Advantage 2 (HMO-POS) offers affordable everyday care with no copay for primary care visits, preventive services, and home health care. Specialist visits, urgent care, and outpatient substance abuse services require a $50 copay, while emergency room visits carry a $130 copay. For inpatient hospital stays, members pay a $385 daily copay for days 1 through 6, with no copay for days 7 and beyond, and outpatient hospital services carry a 25% coinsurance. The plan also features essential routine benefits, including dental cleanings, annual eye exams, and routine hearing tests with no copays. Additionally, members receive a $150 annual eyewear allowance, up to $3,000 for prescription hearing aids, and a $50 quarterly over-the-counter allowance with no copays. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $385 daily copay for days 1 through 6 and no copay for days 7 and beyond. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers outpatient hospital services with no copay and 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 provided with no copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers ground and air ambulance services with a $289.00 copay and no coinsurance, which requires prior authorization and is not waived upon hospital admission. 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 $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Medicare Advantage 2 (HMO-POS) offers primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits, physical, occupational, speech, psychiatric, mental health, and opioid treatment therapies require a $50 copay and no coinsurance, while 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 copays and no coinsurance for covered benefits like annual physical exams, kidney disease education, fitness benefits, and remote access technologies. However, several supplemental services are not covered, including health education, nutritional benefits, in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
Anthem Medicare Advantage 2 (HMO-POS) offers hearing services with no coinsurance, featuring a $50 copay for Medicare-covered exams and no copay for annual routine exams and fittings. Prescription hearing aids are partially covered up to $3,000 annually with no copay, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are covered up to $300 annually with no copay.
Vision Services See details
Anthem Medicare Advantage 2 (HMO-POS) partially covers vision services, providing one routine eye exam per year and a $150 annual allowance for contacts and eyeglasses with no copay and no coinsurance. Prior authorization is required for eye exams, and other eye exam services as well as eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage 2 (HMO-POS) dental services are partially covered, offering covered benefits like Medicare dental, cleanings, oral exams, fluoride, and X-rays with no copay and no coinsurance. However, other diagnostic and preventive services are not covered, and comprehensive services—including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics—are excluded.
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 require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
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 durable medical equipment (DME) with no copay and 0% to 20% coinsurance, while prosthetics and medical supplies are covered 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
Anthem Medicare Advantage 2 (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance, and diagnostic tests with a $0 to $110 copay and no coinsurance. Outpatient x-rays and diagnostic radiological services require a copay starting at $45, while therapeutic radiological services carry a minimum 20% coinsurance.
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 are not covered under Anthem Medicare Advantage 2 (HMO-POS) because all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Anthem Medicare Advantage 2 (HMO-POS) with no coinsurance, featuring 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 inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Medicare Advantage 2 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $50 every three months. Acupuncture, meal benefits, and other additional services are not covered.
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