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 $6700.00 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. You will enjoy 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 have no copay at preferred pharmacies and standard mail order, though standard retail pharmacies require a $10 copay for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% coinsurance. These coinsurance rates apply to standard and preferred pharmacies, with specialty medications limited to a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For specialized care, members pay a $45 copay for specialist visits, while emergency room visits require a $130 copay and urgent care visits require a $30 copay. Inpatient hospital stays require a daily copay of $450 for the first five days of acute stays, with no copay required for subsequent days. Additional benefits include routine dental, vision, and hearing services, which feature no copay for annual exams and cleanings alongside generous annual allowances for eyewear and hearing aids. While home health services and diabetic supplies are available with no copay, other services like durable medical equipment and dialysis require a coinsurance of up to 20%. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 to 5 for acute stays and a $415 daily copay for days 1 to 5 for psychiatric stays, followed by no copay for subsequent unlimited days. Prior authorization is required, and non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center (ASC) and outpatient blood services. Outpatient hospital services require a copay of $0 to $450 (with a $450 copay per stay for observation services), while outpatient substance abuse individual and group sessions have a $45 copay. Prior authorization is required for outpatient hospital, observation, ASC, and substance abuse services.
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 $311.00 copay and no coinsurance, with prior authorization required. Transportation services, including trips to plan-approved or any other health-related locations, are not covered under this plan.
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 limit 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 specialist visits, mental health services, and physical therapy require a $45 copay and no coinsurance. Podiatry and other professional services feature copays ranging from no copay to $45 with no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are only partially covered, excluding fitness, health education, weight management, personal emergency response systems, in-home safety assessments, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, caregiver support, and telemonitoring.
Hearing Services See details
Hearing services covered by Anthem Medicare Advantage (HMO-POS) include routine exams and fittings with no copay or coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered up to a $2,000 annual limit with no copay or coinsurance (excluding inner, outer, and over-the-ear types), and OTC hearing aids are covered up to $300 annually with no copay or coinsurance, with prior authorization required.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no deductibles and no coinsurance, featuring eye exams with a $0 to $45 copay (including routine annual exams with no copay), though other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay up to a $250 annual maximum, but upgrades are not covered.
Dental Services See details
Dental services under the Anthem Medicare Advantage (HMO-POS) plan are partially covered up to a $1,500 annual limit, offering preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive dental services such as restorative care and oral surgery are covered with no copay and a 25% coinsurance, while implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from 0% to 20%.
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, featuring a 0% to 20% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics and medical supplies. Diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization and manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic services with prior authorization, offering no coinsurance, no copay for lab services, and copays from $0 to $95 for diagnostic procedures. Radiological services also require prior authorization and feature 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
Home Health Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) covers some cardiac rehabilitation services with no copay, no coinsurance, and prior authorization required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, including chronic illness meal benefits, Medicare Community Resource Support, and a $30 quarterly over-the-counter limit, while acupuncture is not covered.
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