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 $39.00. 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 $350.00 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)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual drug deductible of $350. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at both preferred and standard pharmacies. For Tier 2 generic medications, there is no copay when using preferred pharmacies or standard mail order, while standard pharmacies charge a copay starting at $10 for a one-month supply. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 30% coinsurance at preferred, standard, and mail-order pharmacies. Specialty drugs in Tier 5 carry a 29% coinsurance for a one-month supply across all available pharmacy options.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care or telehealth visits and a $40 copay for specialists. If you require inpatient hospital care, you will pay a $325 daily copay for the first six days, followed by no copay for any remaining days. Emergency room visits require a $130 copay, while routine home health care is fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as no copay for routine annual eye exams, hearing tests, and preventive dental services like cleanings and X-rays. You can take advantage of a $250 annual eyewear allowance and up to $2,000 for prescription hearing aids with no copay. Durable medical equipment is covered with no copay, though a 0% to 20% coinsurance may apply depending on the equipment.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) inpatient hospital care is partially covered with no coinsurance, excluding upgrades and non-Medicare-covered stays. For Medicare-covered acute stays, you pay a $325 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $325 daily copay for days 1 through 7 and no copay thereafter.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with no coinsurance and a $325 copay per service, though prior authorization is required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage (HMO-POS) with a $130 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 limit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialists, physical therapy, and mental health services require a $40 copay and no coinsurance. Routine podiatry and other healthcare professional services feature copays ranging from $0 to $40 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for annual physical exams, remote access technologies, kidney disease education, and select screenings. However, this benefit is only partially covered, as sub-services such as fitness benefits, health education, weight management, nutritional training, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services covered by Anthem Medicare Advantage (HMO-POS) include Medicare-covered exams for a $40 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids (up to $2,000 annually) and OTC hearing aids (up to $300 annually) both feature no copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no deductibles and no coinsurance, featuring one routine annual eye exam with no copay and a $250 yearly allowance with no copay for eyeglasses and contact lenses. Other eye exam services and eyewear upgrades are not covered, and other covered eye exams may require a copay of up to $40.
Dental Services See details
Dental services are partially covered under the Anthem Medicare Advantage (HMO-POS) plan, featuring no copay and no coinsurance for Medicare-covered dental, annual oral exams, dental X-rays, annual cleanings, and fluoride treatments. Sub-services that are not covered include other diagnostic, other preventive, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
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
Medical equipment is covered by Anthem Medicare Advantage (HMO-POS) with no copays, though prior authorization is required for some services. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies have a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab tests and a $0 to $95 copay for procedures, while radiological services require an $80 copay for X-rays, a minimum $50 copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Anthem Medicare Advantage (HMO-POS) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $15 to $35.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100 with no prior 3-day hospital stay required. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering a meal benefit for chronic illnesses and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered under this plan.
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