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 $4850.00 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 has an enhanced alternative drug benefit. The plan has no deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs and specialty tier drugs at preferred, standard, and standard mail pharmacies. For standard generic drugs, you will pay 20% coinsurance at preferred pharmacies and standard mail, and 25% coinsurance at standard pharmacies. For preferred brand drugs and non-preferred drugs, you will pay 40% and 33% coinsurance respectively at all 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 a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $375. Emergency, primary care, and preventive services are also covered, often with no copay. Additional benefits include hearing, vision, and dental services, with some services having no copay and maximum annual benefits. The plan also covers ambulance, transportation, and home health services. Diagnostic, radiological, and skilled nursing facility services are also covered, with varying cost-sharing amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-7, and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $375, observation services with a $375 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $35 copay for both individual and group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are also covered with no copay, up to 60 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $35 copay. Mental Health Specialty Services have a $35 copay for individual and group sessions. Podiatry Services have a copay between $0 and $35, and routine foot care is covered. Other Health Care Professional visits have a copay between $0 and $20. Psychiatric Services have a $35 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive services include Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services, some of which have a copay. 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. Other covered services include Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $3,000 per year, while OTC hearing aids are covered with no copay and a maximum benefit of $300 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Under the Anthem Medicare Advantage (HMO-POS) plan, vision services include eye exams with a copay between $0 and $35 and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames and upgrades. Routine eye exams are covered with no copay, and a limit of one exam per year. Eyewear has a combined maximum plan benefit coverage of $250 per year.
Dental Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, with no copay. There is a $2,600 annual maximum benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay. 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 these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage (HMO-POS) 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 by the Anthem Medicare Advantage (HMO-POS) plan, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Medicare Advantage (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $50 every three months, which carries forward if unused. The plan also covers a meal benefit with no copay, and other services with no copay. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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