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Anthem I MaineHealth Advantage Extra (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Extra (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 Extra (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I MaineHealth Advantage Extra (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 Extra (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 Extra (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 Extra (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.
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 $420.00 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 Maximum Out-Of-Pocket cost of $5500.00 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
The Anthem I MaineHealth Advantage Extra (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $420.00. During the initial coverage phase, after the deductible is met, you pay coinsurance for your prescriptions. For preferred and standard generics, you pay 15% and 25% coinsurance, respectively. For preferred brands, you pay 25% coinsurance. For non-preferred drugs, you pay 28% coinsurance. For specialty drugs, there is no copay.
Additional Benefits
The Anthem I MaineHealth Advantage Extra (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays, and no copays for ambulatory surgical centers. The plan provides coverage for emergency services, primary care, preventive services, hearing, vision, and dental services, often with no copays or low copays, and includes additional benefits like over-the-counter items and a meal benefit. This plan also covers a range of other services, such as ambulance and transportation services, home health, and skilled nursing facility stays, with specific copays or coinsurance amounts. Additionally, the plan offers coverage for various medical equipment, diagnostic and radiological services, and home infusion bundled services, with copays, coinsurance, or no copays depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. For days 1-7, the copay is $325, and for days 8-90, there is no copay. Additional days for both Acute and Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual and group sessions with a copay of $40, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I MaineHealth Advantage Extra (HMO-POS) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $300 copay and air ambulance services with 20% coinsurance. Transportation Services to a Plan Approved Health-related Location are covered with no copay, for up to 24 one-way trips per year. 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 under the Anthem I MaineHealth Advantage Extra (HMO-POS) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, both with no coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay and no coinsurance, with a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay and require prior authorization, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a $40 copay, and Physician Specialist Services have a $35 copay. Individual and Group Sessions for Mental Health Specialty Services have a $40 copay, and Other Health Care Professional services have a copay between $0 and $20. Individual and Group Sessions for Psychiatric Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay and require authorization, and Additional Telehealth benefits have no copay. Finally, Opioid Treatment Program Services have a $40 copay and require prior authorization.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services including Fitness Benefit, Personal Emergency Response System (PERS), and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), all with no copay, while other services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), and more are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2000 per year, and OTC hearing aids are covered with no copay, up to a maximum of $300 per year.
Vision Services See details
Vision services include eye exams with a copay of $0-$35 and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, which are covered with no copay. Eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
Dental Services, including Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are covered with no copay; however, there is a $1,500 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Anthem I MaineHealth Advantage Extra (HMO-POS) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay ranging from $0 to $70, lab services with no copay, and all radiological services. Diagnostic Radiological Services have a copay ranging from $15 to $325, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Anthem I MaineHealth Advantage Extra (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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I MaineHealth Advantage Extra (HMO-POS) plan, but require prior authorization. You will have 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
Other Services include coverage for over-the-counter items and a meal benefit with no copay, but acupuncture and several other services are not covered. Over-the-counter items have a maximum benefit coverage amount of $105.00 every three months.
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