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 $0.00. 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 $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:
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Drug Coverage
The Anthem Medicare Advantage 3 (HMO) plan features a $300 annual drug deductible. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs across preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also have no copay at preferred pharmacies and standard mail order, with standard retail pharmacy copays ranging from $5 to $15 depending on the supply. For higher-tier medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance. Tier 5 specialty medications require a 29% coinsurance for a one-month supply across standard and preferred network pharmacies.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, telehealth services, and standard preventive care. For specialist visits, urgent care, and outpatient mental health services, members pay a $35 copay and no coinsurance. If you require hospital care, emergency services carry a $115 copay, while inpatient acute hospital stays require a $440 daily copay for days one through five and no copay for subsequent days. This plan also features valuable routine benefits, including vision care with no deductible and up to 14 one-way transportation trips to approved health locations with no copay. Preventive dental cleanings, routine eye exams, and routine hearing aids are available with no copay, though comprehensive dental services require a 25% coinsurance. Additionally, home health services are covered with no copay and no coinsurance, helping you manage your health safely from home.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute care, there is a $440 daily copay for days 1 through 5 and no copay for subsequent unlimited days, while psychiatric stays require a $415 daily copay for days 1 through 5 and no copay thereafter. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage 3 (HMO) with no coinsurance across all services. There is no copay for ambulatory surgical center and blood services, a $35 copay for outpatient substance abuse sessions, and a copay ranging from $0 to $440 for outpatient hospital services, which includes a $440 copay per stay for observation services.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage 3 (HMO) with a $40.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (HMO) covers ground and air ambulance services with a $320 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance, offering up to 14 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage 3 (HMO) with a $115 copay and no coinsurance, while urgently needed services require a $35 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 per service.
Primary Care See details
Anthem Medicare Advantage 3 (HMO) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits, physical and occupational therapies, mental health services, and opioid treatment require a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (HMO) covers Medicare-covered preventive services, annual physical exams, kidney disease education, and remote access technologies with no copay and no coinsurance. Additional preventive services are only partially covered, as the plan does not cover benefits such as fitness programs, health education, in-home safety assessments, and weight management.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage 3 (HMO), offering Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams, fittings, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered up to $2,000 annually with no copay or coinsurance, excluding inner ear, outer ear, and over the ear prescription hearing aids.
Vision Services See details
Anthem Medicare Advantage 3 (HMO) offers partially covered vision services with no deductible and no coinsurance, featuring eye exams with a $0 to $35 copay (including one annual routine exam with no copay) and eyewear with no copay up to a $250 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage 3 (HMO) with a $1,000 yearly maximum, offering preventive care like cleanings and exams for no copay and no coinsurance. Comprehensive services require no copay and a 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 3 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin carries a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Anthem Medicare Advantage 3 (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 3 (HMO) covers medical equipment, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization and vendor limitations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Anthem Medicare Advantage 3 (HMO) plan, with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $95 copay for procedures, while radiological services require a $100 copay and coinsurance for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 3 (HMO) 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 under Anthem Medicare Advantage 3 (HMO) with no coinsurance, but prior authorization is required. While some services are covered, cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 3 (HMO) 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 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 3 (HMO) partially covers other services, offering a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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