A non-government entity
Anthem I MaineHealth Advantage Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Plus (HMO). 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 Plus (HMO) in 2026, please refer to our full plan details page.
Anthem I MaineHealth Advantage Plus (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Maine. 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 Plus (HMO) 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 Plus (HMO).
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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $235.00 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 $6800.00 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:
Sign up for Anthem I MaineHealth Advantage Plus (HMO)
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Drug Coverage
The Anthem I MaineHealth Advantage Plus (HMO) plan features a $235 drug deductible before coverage begins for certain tiers. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescription fills at preferred pharmacies, standard pharmacies, or standard mail order. This makes essential generic and select care medications highly affordable with zero out-of-pocket costs for up to a three-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than set copays. Tier 3 Preferred Brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, or 25% at standard pharmacies. Tier 4 Non-Preferred drugs and Tier 5 Specialty drugs both carry a 30% coinsurance across all pharmacy options, with Tier 5 limited to a one-month supply.
Additional Benefits
The Anthem I MaineHealth Advantage Plus (HMO) plan offers affordable access to core medical services, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive care. For specialized medical care, members can expect a $50 copay for specialist visits, while outpatient hospital services range from no copay up to a $425 copay. Inpatient hospital stays require a $425 daily copay for the first five days, after which there is no copay. Routine vision and hearing services are covered with no copay and no coinsurance, including up to $300 annually for eyewear and up to $2,000 for prescription hearing aids. Medicare-covered dental services and diabetic supplies also feature no copays, though routine dental care is not covered under this plan. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem I MaineHealth Advantage Plus (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $425 daily copay for days 1 through 5 and no copay for additional days, while psychiatric stays require a $415 daily copay for days 1 through 5 and no copay thereafter. Non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem I MaineHealth Advantage Plus (HMO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0.00 to $425.00, observation services cost a $425.00 copay per stay, and outpatient substance abuse sessions carry a $50.00 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Anthem I MaineHealth Advantage Plus (HMO) plan with a $50.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Anthem I MaineHealth Advantage Plus (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, with prior authorization required. Some transportation 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 Plus (HMO) 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 up to a $100,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
Anthem I MaineHealth Advantage Plus (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist, psychiatric, and mental health services require a $50 copay and no coinsurance. Physical and occupational therapies have a $35 copay with no coinsurance, and chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic services.
Preventive Services See details
Preventive services are partially covered by Anthem I MaineHealth Advantage Plus (HMO) with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, remote access technologies, and diabetes self-management. However, several supplemental services are not covered under this plan, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem I MaineHealth Advantage Plus (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $50 copay and no coinsurance, alongside annual routine exams and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are covered up to $2,000 annually and OTC hearing aids up to $300 annually with no copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Anthem I MaineHealth Advantage Plus (HMO) with no copay and no coinsurance, including one routine eye exam per year and up to $300 annually for eyewear such as contacts, lenses, and frames. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem I MaineHealth Advantage Plus (HMO), which offers Medicare-covered dental services with no copay and no coinsurance under prior authorization. Other dental and orthodontic services—including oral exams, cleanings, x-rays, fluoride, preventive care, restorative treatments, endodontics, periodontics, prosthodontics, implants, and oral surgery—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem I MaineHealth Advantage Plus (HMO) with no copay, subject to prior authorization. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem I MaineHealth Advantage Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I MaineHealth Advantage Plus (HMO) covers medical equipment, including 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 are offered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem I MaineHealth Advantage Plus (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $70 copay for diagnostic procedures. Covered radiological services require prior authorization, with a $35 copay for outpatient X-rays, a minimum $35 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem I MaineHealth Advantage Plus (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem I MaineHealth Advantage Plus (HMO) with no copay and no coinsurance, subject to prior authorization. Although some services are covered, specific benefits for cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem I MaineHealth Advantage Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Anthem I MaineHealth Advantage Plus (HMO), which provides a meal benefit for chronic illness and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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