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 KY. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4800.00 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:
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs at preferred, standard, and standard mail pharmacies, as well as no copay for specialty tier drugs at preferred, standard, and standard mail pharmacies. For standard generic drugs, you will pay 20% coinsurance at preferred pharmacies, 25% coinsurance at standard pharmacies, and 20% coinsurance at standard mail pharmacies. For preferred brand drugs, you will pay 40% coinsurance at preferred and standard pharmacies, and at standard mail pharmacies. For non-preferred drugs, you will pay 33% coinsurance at preferred, standard, and standard mail pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $375. Emergency and urgent care services have copays, and ambulance services have a $260 copay. This plan provides coverage for primary care with no copay, and specialist visits have a $35 copay. Preventive services, hearing, vision, and dental services are also covered, often with no copay. Additional benefits include home health services, medical equipment, and diagnostic services with a mix of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-7, and no copay for days 8-90; the plan also covers additional days, but not non-Medicare covered stays and upgrades. For Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-6, and no copay for days 7-90; the plan also covers additional days, but not non-Medicare covered stays.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $375, and observation services have a $375 copay. Ambulatory Surgical Center services and outpatient blood services have no copay, and outpatient substance abuse services have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation to health-related locations. All ambulance services have a $260 copay, while transportation services to plan-approved health-related locations have no copay, with up to 60 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by this plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $35 copay for individual and group sessions. Additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, including Fitness Benefit, Personal Emergency Response System (PERS), and Home and Bathroom Safety Devices and Modifications. Health education, in-home safety assessments, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. 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 exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a plan-specified amount of $3,000 per year, and OTC hearing aids have no copay, with a maximum benefit of $300 per year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, and eyewear such as contact lenses, eyeglasses, and upgrades with no copay. Routine eye exams are covered with no copay and are available once per year. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services, all with no copay and a maximum plan benefit of $2,500 per year. Restorative, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are also covered with no copay.
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 by Anthem Medicare Advantage (HMO-POS). You will pay 20% coinsurance for covered services.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20% and requiring prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by this plan. Diagnostic Procedures/Tests have a copay between $0 and $95, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $375, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan requires prior authorization, and copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," this plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit of $55.00 every three months. Other services, including acupuncture, are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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