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 2025, 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 out of 5 stars in 2025.
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 $41.00. 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 $200.00 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 $6800.00 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 has a $200 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance based on the drug tier and pharmacy type. For preferred generic drugs, you'll pay an $8 copay at preferred pharmacies and $13 at standard pharmacies. Specialty tier drugs have no copay.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services, such as preventive services, hearing and dental exams, home health services, and durable medical equipment. The plan does have some copays for services like inpatient hospital stays, primary care visits, specialist visits, emergency services, and outpatient services. You will also be responsible for coinsurance for some services, such as dialysis, prosthetic devices, and therapeutic radiological services.
Inpatient Hospital See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers inpatient hospital stays, including acute and psychiatric, with a copay of $415 for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric stays are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $415, and observation services with a $415 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while outpatient substance abuse services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage 2 (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. Ground and air ambulance services have a copay of $275, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. 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 2 (HMO-POS) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, and specialist services with a $40 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, physical therapy has a $40 copay, and telehealth has no copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. Additional preventive services such as fitness benefits and remote access technologies may have copays. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay up to a maximum of $300 per year. Prescription hearing aids have a maximum benefit of $2,000 per year, and specific hearing aid types are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with a combined maximum benefit of $175 per year with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Other services like restorative services, endodontics, and orthodontics are covered with no copay. There is a $750 maximum plan benefit coverage amount per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services requiring prior authorization and a doctor's referral. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $30 and $415, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage 2 (HMO-POS) 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 the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 2 (HMO-POS) with prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a $0 copay, up to a maximum of $35 every three months. Acupuncture, Meal Benefit, 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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