A non-government entity
Anthem Medicare Advantage 4 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 4 (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 4 (HMO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 4 (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 4 (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 4 (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 4 (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. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced 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 $4500.00 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 4 (HMO) plan features a $300 drug deductible. Under this plan, there is no copay for Tier 1 preferred generic and Tier 6 select care drugs across preferred, standard, and standard mail order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and standard mail-order, with standard pharmacy copays starting at $5. Higher tier medications require coinsurance rather than flat copayments. Tier 3 preferred brand drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 35% coinsurance. For Tier 5 specialty drugs, you will pay a 29% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage 4 (HMO) plan offers robust coverage with no copay and no coinsurance for primary care visits, telehealth, and routine preventive care. For specialized care, members pay a $30 copay for specialist visits and no copay for home health services, while inpatient acute hospital stays require a daily copay of $395 for the first six days. Emergency room visits carry a $130 copay, and outpatient hospital services feature a copay ranging from no copay to $350. This plan also includes comprehensive dental, vision, and hearing benefits with no copays for routine exams and preventive care. Members benefit from a $250 annual allowance for eyewear, a $2,000 limit for prescription hearing aids, and up to 24 one-way transportation trips to approved health locations per year with no copay. Additionally, the plan covers diabetic supplies and select over-the-counter items with no copay to help you manage your daily health needs affordably.
Inpatient Hospital See details
Anthem Medicare Advantage 4 (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required, and upgrades and non-Medicare-covered stays are not covered. Acute care requires a $395 daily copay for days 1-6 and no copay for days 7 and beyond, while psychiatric care requires a $380 daily copay for days 1-6 and no copay for additional days.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage 4 (HMO) with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. There is no copay or coinsurance for ambulatory surgical center and outpatient blood services, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 4 (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 4 (HMO) covers ground and air ambulance services with a $295 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance for up to 24 one-way trips per year, but trips to any other health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage 4 (HMO) covers emergency services with a $130 copay and urgently needed services with a $45 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Medicare Advantage 4 (HMO) provides primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and opioid treatment require a $30 copay and no coinsurance. Occupational, physical, and speech therapy services have a $15 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem Medicare Advantage 4 (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are only partially covered; remote access technologies are included, but fitness benefits, health education, weight management, in-home safety assessments, PERS, and nutritional therapies are not covered.
Hearing Services See details
Anthem Medicare Advantage 4 (HMO) covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $30 copay, and annual routine exams, fittings, and OTC hearing aids (up to $300) with no copay. Prescription hearing aids are partially covered with no copay up to a $2,000 annual limit, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Anthem Medicare Advantage 4 (HMO) covers vision services with no coinsurance, offering annual routine eye exams and eyewear like glasses and contacts with no copay, up to a $250 yearly limit. Other eye exams carry a copay of up to $30, while eyewear upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Medicare Advantage 4 (HMO) offers partially covered dental services with no copay and no coinsurance for preventive care, up to a $1,500 annual maximum. Comprehensive dental services are covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 4 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage 4 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Anthem Medicare Advantage 4 (HMO) with no copays, though coinsurance ranges from no coinsurance up to 20% depending on the item. Durable medical equipment and prosthetics require prior authorization and carry up to 20% coinsurance, while diabetic equipment and supplies feature no copays and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 4 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and outpatient X-ray services for a $15 copay. Diagnostic procedures, diagnostic radiology, and therapeutic radiology services require a minimum 20% coinsurance, with copayments also applying to diagnostic procedures and diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Anthem Medicare Advantage 4 (HMO) plan with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 4 (HMO) provides coverage for Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Under this plan, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Anthem Medicare Advantage 4 (HMO) with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 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 4 (HMO) provides partial coverage for other services, offering no copay and no coinsurance for covered benefits such as chronic illness meal benefits, Medicare Community Resource Support, and up to $30 every three months for over-the-counter items. Acupuncture is not covered under this plan.
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