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 2025, 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 2025.
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 $150.00 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 $4300.00 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 has a $150 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. Preferred Generic and Specialty Tier drugs have no copay, while other tiers have coinsurance between 20% and 45%. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your costs may be reduced.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a wide array of benefits, including inpatient hospital stays, outpatient services, and emergency care, with varying copays depending on the service. Many services have no copay, such as primary care visits, preventive services, and home health services. The plan also includes coverage for hearing, vision, and dental services. Additional benefits include ambulance services, transportation to health-related locations, and services for mental health, substance abuse, and physical therapy. The plan also covers services such as durable medical equipment, diagnostic and radiological services, and skilled nursing facility stays. There are also over-the-counter benefits and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including services not usually covered by Medicare plans, and require prior authorization. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-6 and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-7 and no copay for days 8-90. Additional days for both Inpatient Hospital-Acute and Psychiatric have 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, including all outpatient hospital services, are covered by the Anthem Medicare Advantage (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $300, while observation services have a $300 copay. Ambulatory Surgical Center (ASC) services and outpatient blood services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage (HMO-POS), with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $275 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a Plan Approved Health-related Location are covered with no copay and no coinsurance for up to 60 one-way trips per year, while 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 Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have a $30 copay; all have no coinsurance.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while specialist services cost $40. Mental health and psychiatric individual and group sessions also have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have no copay. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services are covered, with services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services not covered. Other services like Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are covered with no copay. 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 hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $3,000 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services including eye exams with a copay of $0-$40, and eyewear. Eyewear benefits include contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames with a $0 copay, and a combined maximum of $350 per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Other dental services have a maximum plan benefit coverage of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient x-ray services, are covered. Diagnostic procedures/tests have a copay ranging from $0 to $95, lab services have no copay, diagnostic radiological services have a copay up to $195, and outpatient x-ray services have a $50 copay. Therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (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 none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan, with a $0 copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers over-the-counter items with no copay, and a maximum benefit of $140 every three months. The plan also covers meal benefits and other services with no copay. However, acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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