A non-government entity
Anthem Veteran (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Veteran (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Veteran (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Veteran (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 Veteran (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Veteran (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 Veteran (HMO-POS), 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 $81.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Anthem Veteran (HMO-POS).
Additional Benefits
The Anthem Veteran (HMO-POS) plan offers comprehensive coverage for essential medical care, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. For specialized care, members pay a $40 copay with no coinsurance for specialist visits and physical therapy, while inpatient hospital stays require a $350 daily copay for the first five days and no copay thereafter. Emergency services carry a $115 copay and urgent care visits require a $40 copay, both with no coinsurance. Ancillary benefits include routine vision exams and preventive dental care with no copay, alongside comprehensive dental coverage with a 25% coinsurance up to a $1,000 annual maximum. Additionally, members pay no copay for home health services and the first 20 days of skilled nursing facility care, and receive a $65 quarterly allowance for over-the-counter items with no copay. Durable medical equipment and dialysis services are also covered with coinsurance up to 20%.
Inpatient Hospital See details
Inpatient hospital services under Anthem Veteran (HMO-POS) are covered with no coinsurance, featuring a $350 daily copay for days 1 through 5 and no copay for days 6 and beyond for both acute and psychiatric stays. Prior authorization is required, and sub-services such as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Veteran (HMO-POS) outpatient services are covered with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $350, observation services have a $350 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Veteran (HMO-POS) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Anthem Veteran (HMO-POS) plan, which features a $325 copay and no coinsurance for both ground and air ambulance services requiring prior authorization. While transportation is listed as covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Anthem Veteran (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring 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.
Primary Care See details
Anthem Veteran (HMO-POS) provides primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits, physical therapy, and psychiatric services are covered with a $40 copay and no coinsurance. Occupational therapy requires a $35 copay and no coinsurance, other healthcare professionals have a $0 to $15 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem Veteran (HMO-POS) provides preventive services with no copays and no coinsurance, covering annual physical exams, kidney disease education, and screenings for glaucoma and diabetes. While fitness benefits and remote access technologies are also covered at no cost, several additional services like health education, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Anthem Veteran (HMO-POS) with diagnostic hearing exams requiring a $40 copay, no coinsurance, and prior authorization. Routine hearing exams, fitting evaluations, and OTC hearing aids are not covered, and while some prescription hearing aid services are covered, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services under Anthem Veteran (HMO-POS) are partially covered, offering one annual routine eye exam with no copay, no coinsurance, and no deductible, though prior authorization is required. Other eye exams and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Anthem Veteran (HMO-POS) partially covers dental services up to a $1,000 annual maximum, offering preventive care with no copay and no coinsurance, and comprehensive care with no copay and 25% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Veteran (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Medicare Part B chemotherapy, radiation, and drug therapies require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Veteran (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Veteran (HMO-POS) covers medical equipment with no copays, though coinsurance and prior authorization requirements vary. Durable medical equipment has a 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic supplies and therapeutic shoes are covered with no copays and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Veteran (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $50 copay for diagnostic procedures. Radiological services are also covered with prior authorization required, requiring a $20 copay for X-rays, a minimum $20 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Anthem Veteran (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Veteran (HMO-POS) covers some Cardiac Rehabilitation Services with no coinsurance and required prior authorization, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Veteran (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Veteran (HMO-POS) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $65 every three months. Acupuncture and meal benefits are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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