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 drug deductible of $230. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also feature 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, costs are determined by coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 30% coinsurance at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and covered preventive services, while specialist visits require a $45 copay. Emergency care is available with a $130 copay, and urgent care services cost $30. For hospital stays, inpatient acute care requires a $450 daily copay for the first five days, with no copay thereafter. This plan also features robust dental, vision, and hearing benefits, including no copay for routine exams and preventive dental care. Comprehensive dental treatments carry a 25% coinsurance up to a $1,500 annual limit, while eyewear and prescription hearing aids are covered up to $250 and $2,000 annually, respectively. Additionally, members benefit from no copay on home health services and diabetic supplies, alongside a $30 quarterly over-the-counter allowance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) inpatient hospital services are partially covered with no coinsurance, though prior authorization is required. For Medicare-covered stays, acute care requires a $450 daily copay for days 1 through 5 (no copay thereafter) and psychiatric care requires a $415 daily copay for days 1 through 5 (no copay thereafter), while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $450 copay and observation services with a $450 copay per stay. Ambulatory surgical center and outpatient blood services are offered with no copay or coinsurance, while outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Anthem Medicare Advantage (HMO-POS), with ground and air ambulance services requiring a $315 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with 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 maximum plan benefit of $100,000.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialists, mental health, and therapy services require a $45 copay and no coinsurance. Podiatry services feature a $0 to $45 copay with no coinsurance, and though some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, remote access technologies, and glaucoma screenings. However, sub-services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 benefits, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services under the Anthem Medicare Advantage (HMO-POS) plan feature no deductible, offering routine exams and evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $2,000 annually—excluding inner ear, outer ear, and over-the-ear models—while OTC hearing aids are covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) vision services are partially covered, featuring a $0 to $45 copay and no coinsurance for eye exams, alongside no copay or coinsurance for eyewear up to a $250 annual limit. One routine eye exam per year is available with no copay, while other eye exams and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services up to a $1,500 annual limit, offering preventive care with no copay and no coinsurance, and comprehensive treatments with no copay and 25% coinsurance. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage (HMO-POS) with no copay, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs incur a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (HMO-POS) 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 coinsurance costs vary by service. Durable medical equipment features a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are provided with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic services with no coinsurance, offering no copay for lab tests and a $0 to $95 copay for diagnostic procedures. Covered radiological services require a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology, with prior authorization required.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage (HMO-POS) plan 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 copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services with no copay and no coinsurance, including a chronic illness meal benefit, community resource support, and a $30 quarterly over-the-counter allowance. Acupuncture is not covered under this plan.
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