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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 2025, 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 Select Counties in ME. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $22.00. 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 $300.00 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 $9550.00 (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 $9550.00 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:
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Drug Coverage
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, a preferred generic drug has a $2 copay at a preferred pharmacy, and a non-preferred drug has 29% coinsurance. For those who qualify for the low-income subsidy, the monthly premium for Part D is $22.00. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $395, as well as coverage for ambulance, emergency, and primary care services. Additional benefits include dental, vision, and hearing services, with varying copays and coinsurance. The plan also covers preventive services with no copay, as well as home health, skilled nursing, and medical equipment. Additionally, the plan offers over-the-counter items with no copay up to a quarterly limit. However, cardiac rehabilitation and certain other services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For days 1-5, the copay is $395, and for days 6-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I MaineHealth Advantage Choice (HMO-POS) plan, with a $50 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay and cover up to 60 one-way trips per year using rideshare services, bus/subway, van, or medical transport. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay; there is no coinsurance for either service. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
Primary care physician services are covered with no copay, and chiropractic services have a $20 copay. Occupational therapy services have a $40 copay, and physician specialist services have a $40 copay. Mental health specialty services, including individual and group sessions, have a $40 copay, and podiatry services have a $0-$40 copay. Other health care professional visits have a $0-$20 copay, and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have no copay. Finally, opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, such as fitness benefits, remote access technologies, and home and bathroom safety devices, are covered, but other services like health education and counseling are not covered.
Hearing Services See details
Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $2000 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $40, and eyewear. Eyewear has a 20% coinsurance and a copay for some services, with a combined maximum benefit of $125 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay.
Dental Services See details
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan offers dental services with a $1,750 annual maximum, covering oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. 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 under the Anthem I MaineHealth Advantage Choice (HMO-POS) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered supplies, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, with specified manufacturers for supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $70, Lab Services with no copay, Diagnostic Radiological Services with a copay between $35 and $395, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem I MaineHealth Advantage Choice (HMO-POS) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS). 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
Under the "Other Services" benefit, Anthem I MaineHealth Advantage Choice (HMO-POS) covers over-the-counter items with no copay, up to a maximum of $110 every three months. This plan does not cover acupuncture, meal benefits, or other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services.
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