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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 $590.00 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 $5750.00 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 a $590 deductible for prescription drugs. After the deductible is met, you will pay coinsurance for your prescriptions. The coinsurance amount depends on the drug tier and whether you use a preferred or standard pharmacy. In the initial coverage phase, the plan has 15% or 25% coinsurance for most drugs, with specialty tier drugs having no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Anthem I MaineHealth Advantage Extra (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. The plan provides coverage for several services with no copay, such as primary care visits, preventive services, and dental services, and includes additional benefits like hearing and vision care, as well as ambulance and emergency services. This plan also covers home health services, skilled nursing facilities, and medical equipment with specific cost-sharing arrangements, such as copays and coinsurance. Additionally, the plan offers benefits like transportation services, diagnostic and radiological services, and home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital services are covered. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-7, and no copay for days 8-90, with no coinsurance. Additional days are covered with no copay. Inpatient Hospital Psychiatric services are covered, with a $325 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Additional days 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 $325, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services 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 includes coverage for ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $300 copay, while air ambulance services have 20% coinsurance. Transportation services to plan-approved health-related locations have no copay and are limited 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. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $40 copay. Mental Health Specialty Services have a $40 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20. Psychiatric Services have a $40 copay for individual and group sessions. 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.
Preventive Services See details
Preventive services include no copay for Medicare-covered services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional preventive services, including fitness benefits and remote access technologies, may have a copay.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2,000 per year, and OTC hearing aids are covered with no copay, up to a maximum of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem I MaineHealth Advantage Extra (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $40. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, are covered with no copay, with a combined maximum benefit of $225 per year, but upgrades are not covered.
Dental Services See details
Dental Services are covered, with no copay for 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), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics. Other Dental Services have a $1,500 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. 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 Extra (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 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 are covered, with a minimum copay of $0 for Diagnostic Procedures/Tests and a maximum copay of $70.00 for Diagnostic Procedures/Tests. Lab Services have no copay, while Diagnostic Radiological Services have a minimum copay of $40.00 and a maximum copay of $325.00. Outpatient X-Ray Services have a $40.00 copay, and Therapeutic Radiological Services have a minimum coinsurance of 20%.
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 the specific sub-services of Cardiac Rehabilitation Services, 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. 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 SNF stays are not covered.
Other Services See details
The Anthem I MaineHealth Advantage Extra (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay; however, Acupuncture, 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. The OTC benefit has a maximum coverage amount of $35 every three months.
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