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 KY. 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 $230.00 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 $6300.00 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 $230. For Tier 1 preferred generics and Tier 6 select care drugs, there is no copay for 1-month, 2-month, or 3-month supplies at preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and through standard mail order, though standard retail pharmacies carry a $10 copay for a 1-month supply. Brand-name and specialty medications are subject to coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs require a 25% coinsurance across preferred, standard, and standard mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance, with specialty tier medications limited to 1-month supplies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive healthcare coverage with no copay for primary care doctor visits, preventive care services, and home health care. For specialized medical needs, inpatient hospital stays require a $450 daily copay for the first five days, while emergency room visits have a $130 copay and urgent care costs $30. Outpatient hospital services are also covered with no coinsurance and copays ranging from $0 to $450. In addition to medical care, the plan provides routine dental, vision, and hearing benefits with no copays for annual exams. Members can take advantage of generous allowances, including up to $1,500 for preventive dental care, $300 for eyewear, and up to $2,000 for prescription hearing aids. Essential medical supplies and diabetic equipment are covered with no copay, while durable medical equipment requires 0% to 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, requiring a daily copay of $450 for days 1-5 of acute stays and $415 for days 1-5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and the benefit is partially covered since upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Anthem Medicare Advantage (HMO-POS) plan are covered with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse individual and group sessions require a $45 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Anthem Medicare Advantage (HMO-POS) plan with a $40.00 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 a $260 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is 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 $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a $100,000 maximum plan benefit.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $45 copay and no coinsurance. Some chiropractic services are covered for a $15 copay with no coinsurance, though routine and other 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, including annual physical exams, kidney disease education, and screenings for glaucoma and diabetes. Additional preventive benefits are only partially covered; remote access technologies are included, but fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, bathroom safety modifications, and counseling are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services with no coinsurance, requiring a $45 copay for Medicare-covered exams but no copay for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay up to a $2,000 annual limit, excluding inner ear, outer ear, and over-the-ear types, while over-the-counter hearing aids are covered with no copay up to $300 annually. Prior authorization is required for these hearing benefits.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no coinsurance and no deductibles, though other eye exam services and upgrades are not covered. Routine eye exams have no copay (other covered exams range from $0 to $45), and eyewear options like contacts and eyeglasses have no copay up to a $300 annual maximum.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) dental services are partially covered, offering preventive care with no copay and no coinsurance up to a $1,500 annual maximum, and comprehensive care with no copay and 25% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copays across all categories, including durable medical equipment (DME), prosthetics, and diabetic supplies. DME requires 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment and therapeutic shoes are provided 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, offering lab services with no copay and diagnostic procedures with a $0 to $95 copay, while radiological services require a $50 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 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. Prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage (HMO-POS), 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 SNPs with Highly Integrated Services are not covered.
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