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 2026 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. Beneficiaries enjoy no copay for Tier 1 preferred generics and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Additionally, Tier 2 generic drugs have no copay when filled through preferred pharmacies or standard mail order, though standard retail pharmacies require a $10 copay for a one-month supply. For higher-tier medications, costs are covered via 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 require a 30% coinsurance across preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage featuring no copays for primary care visits, home health services, and select preventive care. For emergency room visits, members pay a $130 copay, while inpatient hospital stays require a daily copay of $450 for the first five days with no copay for subsequent days. Specialist visits and outpatient therapies are available with a $45 copay, and there is no coinsurance for these standard medical services. This plan also includes essential dental, vision, and hearing benefits, featuring no copays for routine eye exams, eyewear up to $200 annually, and preventive dental care up to a $1,500 yearly limit. Prescription hearing aids are covered up to $2,000 with no copay, and members receive a $32 allowance every three months for over-the-counter items. For medical equipment and specialized treatments like dialysis, patients will generally pay no copay but are responsible for a coinsurance of up to 20 percent.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) 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, with no copay for additional days. Prior authorization is required, and non-Medicare-covered stays and acute upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a copay of $0 to $450 (including a $450 copay per stay for observation services), and outpatient substance abuse sessions carry a $45 copay.
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 for this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $299.00 copay and no coinsurance, requiring prior authorization. Transportation services to plan-approved or 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 up to a $100,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapies, and mental health services require a $45 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic care are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, remote access technologies, and select screenings. However, several supplemental services are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing exams with a $45 copay and no coinsurance for Medicare-covered visits, while routine annual exams, fittings, and OTC hearing aids (up to $300 yearly) have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual maximum, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services covered by Anthem Medicare Advantage (HMO-POS) feature no deductible and no coinsurance, offering eye exams with a $0 to $45 copay and eyewear with no copay. This partially covered benefit includes one routine eye exam and up to $200 for eyewear per year, though other eye exams and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive dental services with no copay and no coinsurance up to a $1,500 annual maximum. Comprehensive dental services are partially covered with no copay and a 25% coinsurance, though implant services, orthodontics, and maxillofacial prosthetics 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 require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
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, though coinsurance requirements vary. Durable medical equipment requires prior authorization with no copay and up to 20% coinsurance, prosthetics and medical supplies carry no copay and 20% coinsurance, and diabetic equipment is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services, subject to prior authorization, with lab services offered at no copay and diagnostic procedures ranging from a $0 to $95 copay with no coinsurance. Diagnostic radiological services and outpatient X-rays require a copay starting at $50, while therapeutic radiological services carry a minimum 20% coinsurance.
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
Cardiac Rehabilitation Services are technically covered under the Anthem Medicare Advantage (HMO-POS) plan with no coinsurance and prior authorization required, though in practice only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Anthem Medicare Advantage (HMO-POS) plan, featuring no copay and no coinsurance for over-the-counter items up to $32 every three months, chronic illness meal benefits, and community resource support. Acupuncture is not covered under this plan.
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