A non-government entity
Anthem I MaineHealth Advantage Choice (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Choice (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem I MaineHealth Advantage Choice (HMO-POS) in 2026, please refer to our full plan details page.
Anthem I MaineHealth Advantage Choice (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Cumberland and York Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem I MaineHealth Advantage Choice (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 I MaineHealth Advantage Choice (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 I MaineHealth Advantage Choice (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $250.00 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 I MaineHealth Advantage Choice (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem I MaineHealth Advantage Choice (HMO-POS) Medicare plan has an annual drug deductible of $250. You can save on generic medications with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using preferred pharmacies or standard mail order. Additionally, Tier 6 (Select Care Drugs) feature no copay across all standard and preferred pharmacies, as well as standard mail order. For brand-name and specialty medications, your costs are based on coinsurance. Tier 3 (Preferred Brand) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 30% coinsurance at both preferred and standard pharmacies. Specialty drugs in Tier 5 are limited to a one-month supply and also require a 30% coinsurance.
Additional Benefits
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan offers affordable medical coverage with no copay for primary care doctor visits, annual physical exams, and home health services. For specialized medical care, members will pay a fifty-dollar copay for specialist visits, a one-hundred-fifteen-dollar copay for emergency room care, and a three-hundred-ninety-five-dollar daily copay for the first several days of inpatient hospital stays. Most outpatient and diagnostic services feature no coinsurance, keeping out-of-pocket costs predictable for members. Additional benefits include routine vision and hearing exams with no copay, alongside allowances of up to two thousand dollars for hearing aids and one hundred fifty dollars for eyewear. While routine dental services are not covered, the plan provides Medicare-covered dental care and the first twenty days of skilled nursing facility stays with no copay. Members also receive a thirty-five-dollar quarterly allowance with no copay or coinsurance to purchase approved over-the-counter health items.
Inpatient Hospital See details
Anthem I MaineHealth Advantage Choice (HMO-POS) partially covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For covered services, acute stays require a $395 daily copay for days 1-6 and psychiatric stays require a $395 daily copay for days 1-5, with no copay for additional days.
Outpatient Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $395 for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $50 copay per session with no coinsurance.
Partial Hospitalization See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with a $300 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Although transportation services are listed as covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Anthem I MaineHealth Advantage Choice (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 with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem I MaineHealth Advantage Choice (HMO-POS) primary care and telehealth services are available with no copay and no coinsurance, while specialist, psychiatric, and mental health visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay and no coinsurance, podiatry is not covered, and though some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, with services like fitness benefits, health education, nutritional benefits, and in-home safety assessments excluded from coverage.
Hearing Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers Medicare-covered hearing exams with a $50 copay and no coinsurance, while routine hearing exams and fittings are fully covered with no copay and no coinsurance. Prescription hearing aids are covered up to $2,000 annually and over-the-counter hearing aids up to $300 annually with no copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription types are not covered.
Vision Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) offers partially covered vision services, including one annual routine eye exam with no copay and no coinsurance, while other eye exams are not covered. Eyewear is covered up to a $150 annual maximum with no copay, featuring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, though upgrades are not covered.
Dental Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) provides partial coverage for dental services, offering Medicare-covered dental services with no copay and no coinsurance, subject to prior authorization. Routine and preventive sub-services, including oral exams, cleanings, dental x-rays, fluoride treatments, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin is available with a $35 copay and no coinsurance.
Dialysis Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers medical equipment, featuring durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Prosthetic devices and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures and tests carry no coinsurance and a $0 to $70 copay, lab services have no copay or coinsurance, and radiological services require a $40 copay for X-rays, a minimum $40 copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) provides partial coverage for other services, offering Medicare Community Resource Support and a $35 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved