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 Suffolk 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 $71.00. 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 $6950.00 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 (HMO-POS) plan has a $395 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $15 copay at preferred pharmacies. In the initial coverage phase, you'll pay these costs until your total drug costs reach $2,000. Once you reach this amount, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers coverage for a variety of services. Inpatient hospital stays have a copay of $410 for days 1-5, and then no copay for days 6-90. The plan also covers outpatient services, primary care, preventive services, hearing, vision, dental, home health, and medical equipment. Many services have copays, including emergency services, specialist visits, and mental health services. There is no copay for many services, including an annual physical exam, lab services, and home health services. The plan also offers coverage for OTC items, with a maximum benefit of $45 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $410 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services including outpatient hospital services, observation services, and ambulatory surgical center services are covered. Outpatient hospital services have a 25% coinsurance and no copay, while observation services have a 25% coinsurance. Ambulatory Surgical Center (ASC) Services have a 20% coinsurance and no copay. Outpatient substance abuse services are covered, with individual and group sessions having a copay between $40 and $40. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $280 copay and no coinsurance, however, transportation services to any health-related location are not covered. All ambulance services require prior authorization.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services and chiropractic services with a $15 copay, occupational therapy with a $35 copay, and specialist services with a $50 copay. Mental health and psychiatric individual and group sessions have a $40 copay, physical therapy and speech-language pathology services have a $40 copay, telehealth has no copay, and opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional services such as fitness benefits and remote access technologies, which may have a copay. Other preventive services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing exams require a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a plan maximum of $2,000 per year, and OTC hearing aids have no copay with a maximum benefit of $300 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, and eyewear with no copay. Eyewear includes a combined maximum of $200 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, while upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams and prophylaxis (cleaning) with no copay; however, dental x-rays and fluoride treatments are offered as optional, supplemental benefits. Orthodontic services, restorative services, and many other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Medicare Advantage (HMO-POS) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0% to 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $40 and $300, and Outpatient X-Ray Services have a $40 copay. Therapeutic Radiological Services have a 20% coinsurance.
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 by the Anthem Medicare Advantage (HMO-POS) plan, but there is no information about the cost sharing for the service. Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $45.00 every three months; however, acupuncture, meal benefits, 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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