A non-government entity
Anthem Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 2 (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 2 (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 2 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. 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 $150.00 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 2 (HMO-POS) plan features a $150 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when filled through preferred pharmacies or standard mail order. For Tier 2 generic drugs, copays start at just $4 for a one-month supply at preferred pharmacies and standard mail order, compared to $9 at standard pharmacies. For brand-name and specialty medications, costs are based on a percentage of the drug price. You will pay a 25% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty medications carry a 31% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers affordable access to essential medical care, featuring a low $5 copay for primary care visits, a $55 copay for specialists, and no copay for telehealth. Inpatient hospital stays require a $415 copay for the first few days with no copay for subsequent days, while emergency room visits carry a $115 copay. Outpatient services are also accessible, featuring no coinsurance and copays ranging from $0 to $415 depending on the service. This plan also covers key supplemental benefits, including preventive dental care, routine eye exams, and routine hearing exams with no copay and no coinsurance. Beneficiaries can take advantage of a $175 annual eyewear allowance and up to $2,000 for prescription hearing aids with no copay. Additionally, home health services and diabetic supplies are covered with no copay, though durable medical equipment may require up to 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $415 copay for days 1 to 5 (with no copay for days 6 and beyond), and psychiatric stays require a $415 copay for days 1 to 4 (with no copay for days 5 and beyond), though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $415, alongside observation services at a $415 copay per stay. Ambulatory surgical center and blood services feature no copay and no coinsurance, while outpatient substance abuse sessions have a $55 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization, and this copay is not waived if you are admitted to the hospital. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, while urgently needed services require a $40 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 2 (HMO-POS) covers primary care visits for a $5 copay and specialist visits for a $55 copay, both with no coinsurance. Telehealth services feature no copay, therapy services require a $35 copay, and mental health, psychiatric, and opioid treatments have a $50 to $55 copay, all with no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance for covered benefits, which include annual physical exams, kidney disease education, remote access technologies, diabetes self-management, and glaucoma screenings. Sub-services that are not covered under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers hearing services with no copay and no coinsurance for annual routine exams and fitting evaluations, though Medicare-covered exams require a $55 copay and no 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 models, while over-the-counter (OTC) hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 2 (HMO-POS) with no deductible, no coinsurance, and no copay for annual routine eye exams and eyewear, which has a $175 yearly limit. Other eye exam services and eyewear upgrades are not covered, and prior authorization is required for eye exams.
Dental Services See details
Anthem Medicare Advantage 2 (HMO-POS) offers partially covered dental services, featuring no copay and no coinsurance for preventive care up to a $750 annual maximum, and no copay with 25% coinsurance for comprehensive services. Implant services, orthodontics, and maxillofacial prosthetics are not covered under this plan.
Home Infusion bundled Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage 2 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (HMO-POS) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance, though manufacturer limitations apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic lab services feature no copay or coinsurance, while other diagnostic procedures cost between $0 and $150, and radiological services require a $30 copay for X-rays, a minimum $30 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 2 (HMO-POS) covers some cardiac rehabilitation services with no coinsurance and prior authorization, but several key services are not covered. Specifically, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 2 (HMO-POS) 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, a $218 copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Anthem Medicare Advantage 2 (HMO-POS) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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