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 $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:
Sign up for Anthem Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual prescription drug deductible of $230. You will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs also have no copay at preferred pharmacies and standard mail order, while standard pharmacies require a $10 copay for a one-month supply. For higher-tier medications, this plan transitions to coinsurance rather than flat copayments. You will pay 25% coinsurance for Tier 3 preferred brand drugs and 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 30% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
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. Specialist visits and outpatient therapies require a $45 copay, while inpatient hospital stays incur a daily copay of $450 for the first five days. Outpatient services feature no coinsurance and copays ranging from no copay up to $450 depending on the specific procedure. This plan also includes valuable supplemental benefits, including routine vision and hearing exams with no copay, alongside allowances of up to $200 for eyewear and $2,000 for prescription hearing aids. Preventive dental care is fully covered with no copay or coinsurance, while comprehensive dental services require a 25% coinsurance. Additionally, members benefit from a $35 quarterly allowance for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Acute hospital stays require a $450 daily copay for days 1 through 5 and no copay for additional days, while psychiatric stays require a $415 daily copay for days 1 through 5 and no copay thereafter.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also have no copay. Outpatient hospital services carry a copay of $0 to $450, observation services require a $450 copay per stay, and outpatient substance abuse sessions have a $45 copay, all with no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $304 copayment and no coinsurance, though prior authorization is required. Routine transportation services to plan-approved or health-related locations are not covered in practice under this plan.
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 up to a $100,000 maximum benefit, each subject to a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical and occupational therapies, and mental health services require a $45 copay and no coinsurance. Podiatry and other healthcare professional services have copays ranging from $0 to $45 and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and remote access technologies. However, several sub-services are not covered, including 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, palliative care, in-home support, caregiver support, additional smoking cessation, fitness, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) hearing services include Medicare-covered exams for a $45 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $2,000 annually—though inner ear, outer ear, and over the ear models are not covered—while OTC hearing aids are covered with no copay and no coinsurance up to $300 annually.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) covers vision services with no deductible, offering one routine eye exam per year and eyewear up to a $200 annual limit with no copay and no coinsurance. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services, providing preventive and diagnostic care with no copay and no coinsurance up to a $1,500 annual maximum. Comprehensive dental services are covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance. Medicare Part B insulin is also covered with a $35 copay and no coinsurance, and this cost-sharing does not count toward any plan-level deductible.
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, but coinsurance may apply depending on the service. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic supplies and services are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $95 copay for diagnostic procedures. Covered radiological services require prior authorization and include a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, though prior authorization is required. Members will pay a $35 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is 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) provides partially covered other services, including over-the-counter items with a $35 quarterly limit, meal benefits for chronic illnesses, and community resource support, all with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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