A non-government entity
Anthem Medicare Advantage 3 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 3 (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 3 (HMO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 3 (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Indiana. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 3 (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 3 (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 3 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.00. 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 $300.00 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 $5150.00 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 3 (HMO) plan features a $300 drug deductible and offers excellent savings on generic medications. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also have no copay at preferred pharmacies and standard mail order, though standard pharmacies charge a copay starting at $5 for a one-month supply. For higher-tier medications, the plan transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance across all pharmacy options. Specialty drugs in Tier 5 are covered with a 29% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, preventive screenings, and home health services. For specialized medical care, members pay copays ranging from $25 to $35 with no coinsurance, while emergency room visits carry a $130 copay. Inpatient hospital stays require daily copays for the first six days with no coinsurance, and skilled nursing facility stays have no copay for the first 20 days. This plan also provides valuable supplemental benefits, including no copay for routine vision exams, annual hearing tests, and preventive dental care. Prescription hearing aids are covered up to $2,000 annually, routine eyewear is covered up to $250, and comprehensive dental services require a 25% coinsurance with no copay up to a $1,500 limit. Additionally, members can access up to 24 one-way trips to approved health locations and receive over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $395 for days 1 to 6 of acute stays and $380 for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and some services such as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $35 copay for substance abuse sessions, and copays ranging from no copay up to $350 for outpatient hospital and observation services. Prior authorization is required for outpatient hospital, observation, ambulatory surgical, and substance abuse services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Anthem Medicare Advantage 3 (HMO) plan with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (HMO) covers ground and air ambulance services with a $325 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Anthem Medicare Advantage 3 (HMO) covers emergency services with a $130 copay and urgently needed services with a $45 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan limit of $100,000.
Primary Care See details
Anthem Medicare Advantage 3 (HMO) covers primary care provider visits and telehealth services with no copay and no coinsurance. Specialized services, including specialist visits, mental health, psychiatric, and physical or occupational therapy, are covered with no coinsurance and copays ranging from $25 to $35, while chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (HMO) provides coverage for preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, with remote access technologies available at no cost, while services such as fitness benefits, health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Anthem Medicare Advantage 3 (HMO) covers hearing services, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, though inner ear, outer ear, and over the ear types are not covered, while OTC hearing aids are covered with no copay or coinsurance up to a $300 limit.
Vision Services See details
Vision services are covered by Anthem Medicare Advantage 3 (HMO) with no coinsurance, featuring no copay for one routine eye exam per year and no copay for eyewear up to a $250 annual limit. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage 3 (HMO) partially covers dental services up to a $1,500 annual maximum, offering preventive care with no copay and no coinsurance. Comprehensive dental services are covered with no copay and a 25% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage 3 (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation, have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage 3 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 3 (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization and manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and outpatient X-rays for a $25 copay, both subject to coinsurance. Other diagnostic, therapeutic, and radiological services require copays and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage 3 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage 3 (HMO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 3 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the standard Medicare-covered limit.
Other Services See details
Anthem Medicare Advantage 3 (HMO) provides partially covered other services, offering over-the-counter items, chronic illness meals, and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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