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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 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 Select Counties in ME. 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 $55.00. 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 $150.00 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)
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Drug Coverage
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan features an annual drug deductible of $150 and offers cost-saving opportunities on generic medications. Members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or standard mail order. Tier 6 select care drugs also feature no copay across all preferred, standard, and mail order pharmacy options. For brand-name and specialty drugs, cost sharing is based on coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance at standard and preferred pharmacies. Tier 5 specialty drugs require a 31% coinsurance for a one-month supply across all fulfillment methods.
Additional Benefits
The Anthem I MaineHealth Advantage Choice (HMO-POS) plan offers robust medical coverage featuring no copay for primary care doctor visits, annual physicals, and routine eye exams. For more intensive care, inpatient hospital stays require a daily copay of $395 for the first several days followed by no copay, while emergency room visits have a flat $115 copay. Outpatient care and specialist visits are also highly accessible, featuring no coinsurance and predictable copays. This plan also includes valuable everyday benefits, such as no copay for routine hearing exams, prescription hearing aids up to a $2,000 annual limit, and a $125 allowance for eyewear. While routine dental services are not covered, members pay no copay for Medicare-covered dental care and diabetic supplies. Additionally, the plan features a $35 quarterly allowance for over-the-counter items with no copay, alongside durable medical equipment covered with coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem I MaineHealth Advantage Choice (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $395 for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no coinsurance, including outpatient hospital services with a $0 to $395 copay and observation services with a $395 copay per stay. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions have a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem I MaineHealth Advantage Choice (HMO-POS) plan with a $50.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
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 with no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered up to a $100,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $45 copay and no coinsurance. Physical and occupational therapy services have a $35 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, and remote access technologies. This benefit is partially covered, excluding services like fitness, health education, PERS, weight management, alternative therapies, therapeutic massage, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, and home safety modifications.
Hearing Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, while routine hearing exams, fitting evaluations, and OTC hearing aids (up to $300 annually) have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Anthem I MaineHealth Advantage Choice (HMO-POS) provides partially covered vision services, offering one routine eye exam per year with no copay and no coinsurance, while other eye exams and upgrades are not covered. Covered eyewear, including eyeglasses and contact lenses, features no copay and a $125 annual maximum benefit, though contact lenses are subject to a 20% coinsurance.
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 comprehensive dental services, including oral exams, cleanings, x-rays, and orthodontic procedures, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Medicare Part B chemotherapy, radiation, and infusion drugs feature no copay and a coinsurance ranging from 0% to 20%.
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, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Prosthetics and medical supplies are covered with no copay and 20% coinsurance, while diabetic equipment and supplies feature 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. Diagnostic tests range from no copay to a $70 copay with no coinsurance, while lab services have no copay and no coinsurance. Diagnostic radiology requires a copay starting at $35 with no coinsurance, outpatient X-rays require a $35 copay, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by Anthem I MaineHealth Advantage Choice (HMO-POS) with no copay, no coinsurance, and prior authorization required. However, in practice only some services are covered, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services 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 and no prior three-day inpatient hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare limit.
Other Services See details
Other Services under the Anthem I MaineHealth Advantage Choice (HMO-POS) plan are partially covered, offering Medicare Community Resource Support and Over-the-Counter (OTC) items (up to $35 every three months) with no copay and no coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs 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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