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Anthem I MaineHealth Advantage Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Plus (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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I MaineHealth Advantage Plus (HMO-POS) is a HMO-POS 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 out of 5 stars in 2025.
It's important to know that Anthem I MaineHealth Advantage Plus (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 Plus (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 Plus (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 $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 Maximum Out-Of-Pocket cost of $6750.00 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 Plus (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay the following costs for your medications. For preferred generic drugs, you will pay a $4 copay at a preferred pharmacy, and a $9 copay at a standard pharmacy. For standard generic, preferred brand, and non-preferred drugs, you will pay coinsurance. For specialty tier drugs, there is no copay.
Additional Benefits
The Anthem I MaineHealth Advantage Plus (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay of $395 for days 1-5, with no copay for subsequent days. Outpatient services, primary care, and preventive services often have no copay, but some services have copays ranging from $20-$40. The plan also covers emergency services with a $125 copay, and ambulance services with a $300 copay for ground transport and 20% coinsurance for air transport. Additionally, the plan includes benefits for hearing, vision, and dental services, with no copays for many services, as well as home health services and skilled nursing facilities, with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care, but require prior authorization. For days 1-5, there is a $395 copay, and days 6-90 have no copay. Additional days for inpatient hospital are covered with no copay. Non-Medicare-covered stays and upgrades 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, Individual and Group Sessions for Outpatient Substance Abuse with a $40 copay, and Outpatient Blood Services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I MaineHealth Advantage Plus (HMO-POS) plan, requiring prior authorization and a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem I MaineHealth Advantage Plus (HMO-POS) plan. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location are covered for 60 one-way trips per year with no copay, and 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 by the Anthem I MaineHealth Advantage Plus (HMO-POS) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay and no coinsurance, with a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $40 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, Podiatry Services with a copay between $0 and $35, Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered zero dollar services, annual physical exams, and additional preventive services, are covered. Annual physical exams have no copay. Additional preventive services may have a copay, and the plan also covers Fitness Benefits, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. Some services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Anthem I MaineHealth Advantage Plus (HMO-POS) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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. Routine eye exams are covered with no copay, and eyewear benefits include contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered under the Anthem I MaineHealth Advantage Plus (HMO-POS) plan, with a $1,200 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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 all have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Anthem I MaineHealth Advantage Plus (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20% with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for 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 20% coinsurance, and Outpatient X-Ray Services with a $35 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by Anthem I MaineHealth Advantage Plus (HMO-POS) 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 specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I MaineHealth Advantage Plus (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 stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Other 1, both with no copay, while acupuncture, meal benefits, 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 items benefit has a maximum plan benefit coverage amount of $89.00 every three months.
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