A non-government entity
Anthem Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (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 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Nassau County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (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 (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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.00. 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 $395.00 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 $8300.00 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 (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan has a $395.00 deductible for prescription drugs. In the initial coverage phase, you'll pay different amounts depending on the drug tier and pharmacy. For example, you may have no copay for preferred generic drugs at a preferred pharmacy, or 20% coinsurance for standard generic drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium may be reduced to $44.80. Check the plan's formulary for specific drug coverage details.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a range of benefits with varying cost-sharing. It covers inpatient hospital stays with a $400 copay for days 1-5, and no copay for days 6-90, and outpatient services with coinsurance or copays depending on the service. Emergency services have a $110 copay, while primary care visits have a $15 copay, and specialist visits have a $50 copay. Additional benefits include coverage for preventive services, hearing exams, and vision services. Hearing exams have a $50 copay and routine hearing exams have no copay. Vision services include eye exams with a copay between $0 and $50, and eyewear with no copay, with a combined maximum benefit of $125 per year. The plan also covers dental services with no copay for oral exams and cleanings, and offers other services like home health with no copay, and skilled nursing facility (SNF) with a copay after day 20.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, you will pay a $400 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 25% coinsurance and no copay, observation services with a 25% coinsurance, ambulatory surgical center services with a 20% coinsurance and no copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $310 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Anthem Medicare Advantage (HMO-POS) plan, with a $110 copay for emergency services, and no coinsurance. Urgently Needed Services are also covered, with a $45 copay, and no coinsurance. Worldwide Emergency Services are covered with a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with no coinsurance, and a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy, specialist services, mental health services, other health care professionals, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services and chiropractic services have a $15 copay, while specialist services have a $50 copay. Occupational therapy services, physical therapy, and speech-language pathology services have a $35 copay. Individual and group sessions for both mental health and psychiatric services have a $40 copay. Other health care professionals have a copay between $15 and $20, and opioid treatment program services have a $40 copay. Additional telehealth benefits have no copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for services like annual physical exams with no copay. Additional preventive services like fitness benefits, and remote access technologies are covered with no copay. Some preventive services, such as health education, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay and a maximum benefit of $300 per year. Prescription hearing aids are covered with a maximum benefit of $2000 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $50, and eyewear with no copay, but with a combined maximum benefit of $125 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with no copay, while upgrades are not covered.
Dental Services See details
Dental Services are covered by Anthem Medicare Advantage (HMO-POS), with no copay for oral exams and prophylaxis (cleaning), though each is limited to one visit per year. Dental X-Rays and fluoride treatments are offered as optional, supplemental benefits. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250 with a minimum copay of $45, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
The Anthem Medicare Advantage (HMO-POS) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers a meal benefit with no copay. Acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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