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 2025, 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 out of 5 stars in 2025.
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 $75.00. 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:
Sign up for Anthem Veteran (HMO-POS)
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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 a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for the first five days, with no copay for the remaining days. Outpatient services and preventive services, including annual physical exams, have no copay. The plan covers primary care with a $10 copay, and specialist visits for $30. Emergency services have a $110 copay, and ambulance services have a $260 copay. Dental services, including exams, X-rays, and cleanings, are covered with no copay, up to a $1000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $350 copay for days 1-5, and no copay for days 6-90; however, non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $350, while observation services have a $350 copay. Ambulatory surgical center services and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Veteran (HMO-POS) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Veteran (HMO-POS) plan. Ground and Air Ambulance Services have a $260 copay, 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services has a $45 copay.
Primary Care See details
The Anthem Veteran (HMO-POS) plan covers primary care physician services with a $10 copay. Chiropractic services are covered with a $15 copay. Occupational therapy services have a $35 copay. Physician specialist services have a $30 copay. Individual and group sessions for mental health specialty services have a $40 copay. Other health care professional visits have a copay between $10 and $20. Individual and group sessions for psychiatric services have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have no copay. Opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additionally, services such as Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services are partially covered by the Anthem Veteran (HMO-POS) plan. Hearing exams have a $30 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $30, with routine eye exams having no copay. Eyewear benefits are covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Anthem Veteran (HMO-POS) plan covers dental services, including oral exams, dental X-rays, other diagnostic services, cleaning, and fluoride treatments with no copay, and a maximum benefit of $1000 per year. The plan also covers orthodontic services, restorative services, and more with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Veteran (HMO-POS) plan. 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 is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Veteran (HMO-POS) plan. There is a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-rays, are covered by this plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $20 and $350, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Anthem Veteran (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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required, and copays may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Veteran (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Anthem Veteran (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $64.00 every three months. 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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