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 $4150.00 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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs. For standard generic drugs, you will pay 20% coinsurance at a preferred pharmacy and 25% at a standard pharmacy. 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, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care visits, many preventive services, and some vision and dental services. The plan also includes coverage for hearing exams and hearing aids, as well as medical equipment and home health services. Other key benefits of this plan include coverage for emergency services, ambulance services, and transportation to health-related locations. Additionally, the plan covers services like partial hospitalization, skilled nursing facility stays (with copays after day 20), and home infusion bundled services. The plan also offers coverage for home infusion bundled services, and dialysis services with a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For days 1-7, the copay is $295 per admission, and for days 8-90, there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $295, observation services have a $295 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage (HMO-POS) 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 covered with no copay.
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 and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $30 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, while chiropractic services have a $20 copay and require prior authorization. Occupational therapy services have a $35 copay, while physician specialist services have a $35 copay. Mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a $35 copay, and physical therapy and speech-language pathology services have a $35 copay. Additionally, podiatry services and other health care professional services have copays ranging from $0 to $35, and additional telehealth benefits are covered with no copay.
Preventive Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered. The plan also covers Personal Emergency Response Systems, Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a 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, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year. Prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with a maximum plan benefit coverage of $250 per year and no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental services are covered, with a $2,500 annual maximum benefit, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, other preventive services, restorative services, and more, all with no copay. Orthodontic services are covered under diagnostic and preventive dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. 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 under the Anthem Medicare Advantage (HMO-POS) plan. You will pay a 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, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and there are preferred manufacturers for DME and Diabetic Supplies.
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 $295, Therapeutic Radiological Services have a coinsurance of at least 20%, 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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Medicare Advantage (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan, 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, as well as Non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and for Medicare Community Resource Support with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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