A non-government entity
Anthem Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Medicare Advantage (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage (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 Medicare Advantage (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 Medicare Advantage (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 $315.00 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 $4400.00 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 Medicare Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual prescription drug deductible of $315. For Tier 1 preferred generics and Tier 6 select care drugs, the plan offers no copay for one, two, or three-month fills at preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and standard mail order, while standard retail pharmacies charge a $10 copay for a one-month supply. For higher-tier medications, costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require 25% coinsurance, and Tier 4 non-preferred drugs require 30% coinsurance at preferred, standard, and standard mail-order pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $40 copay for specialist visits, while emergency room services require a $130 copay. Inpatient hospital stays feature a $250 daily copay for the first six days and no copay for additional days, with no coinsurance required. This plan also includes valuable supplemental benefits, featuring no copay or coinsurance for routine dental cleanings, annual eye exams, and routine hearing tests. Members receive allowances for eyewear up to $150 and hearing aids up to $2,000, alongside no copay for diabetic supplies. While many diagnostic and home infusion services have no copay, dialysis services and certain durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 6 and no copay for days 7 and beyond. While unlimited additional days are covered with no copay, prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital and observation services require a copay of $0 to $300, while outpatient substance abuse individual and group sessions have a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Anthem Medicare Advantage (HMO-POS) plan with a $325 copay and no coinsurance for Medicare-covered ground and air ambulance services, which require prior authorization. While some transportation services are covered, trips to plan-approved health-related locations or any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum plan benefit with a $130 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $40 copay and no coinsurance. Podiatry services are covered with a $0 to $40 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services—including annual physical exams, kidney disease education, glaucoma screenings, and remote access technologies—with no copay and no coinsurance. These benefits are partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) hearing services include Medicare-covered exams for a $40 copay and no coinsurance, plus routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, though inner ear, outer ear, and over the ear types are not covered, while over-the-counter hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), offering one routine eye exam per year with no copay and no coinsurance. Covered eyewear, including lenses, frames, and contacts, also features no copay and no coinsurance up to a $150 annual limit, but other eye exams and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) provides partially covered dental services with no copay and no coinsurance for covered care, which includes Medicare-covered dental, annual cleanings, oral exams, x-rays, and fluoride treatments. However, orthodontic, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies, though coinsurance ranges from 0% to 20% for DME and is 20% for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are fully covered with no copay and no coinsurance, though manufacturer limitations and prior authorizations may apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services. Diagnostic tests range from a $0 to $95 copay with no coinsurance, while radiological services require either a copay starting at $50 or a minimum 20% coinsurance depending on the service.
Home Health Services See details
Home health services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage (HMO-POS) plan. Although the plan features no coinsurance, all sub-services—including pulmonary, cardiac, intensive cardiac, and SET for PAD rehabilitation—are not covered and require copays ranging from $15 to $35.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. Patients pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services with no copay and no coinsurance, including a chronic illness meal benefit, community resource support, and up to $15 every three months for over-the-counter items. Acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved