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 Wisconsin. 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 a $150.00 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 $4151.00 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 $150 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs and specialty tier drugs have no copay, while standard generic drugs have a 20-25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. Those who qualify for the low-income subsidy will have their premium reduced.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, primary care with no copay, and various specialist services with a $40 copay. This plan also covers emergency, ambulance, and worldwide emergency services, along with preventive, hearing, vision, and dental services, and home health services. There is no copay for many services, including routine foot care, hearing aids, and eyewear, and offers a wide array of additional benefits like home infusion services, medical equipment, and skilled nursing facility (SNF) services.
Inpatient Hospital See details
Inpatient Hospital services are covered by Anthem Medicare Advantage (HMO-POS), with a copay of $325 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $250 for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have a copay of $0-$300, Observation Services have a copay of $300, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $290 copay, and transportation services to plan-approved health-related locations with no copay for up to 60 one-way trips per year. Transportation services to any health-related location are 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 and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation and Worldwide Urgent Coverage have a $90 copay.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay and require prior authorization, while routine chiropractic care is not covered. Occupational therapy services have a $40 copay and require prior authorization. Specialist services have a $40 copay, and mental health services have a $40 copay for individual and group sessions. Podiatry services may have up to a $40 copay, and routine foot care has no copay. Other health care professionals have a copay between $0 and $20, and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay and require prior authorization. Additional telehealth benefits have no copay. Opioid treatment program services have a $40 copay and require prior authorization.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, while other preventive services like health education, in-home safety assessments, personal emergency response systems (PERS), and others are not covered. Additional preventive services like Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications are covered, but may have a copay.
Hearing Services See details
Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $3000 per year with no copay, while OTC hearing aids have a maximum benefit of $300 per year and no copay.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear such as contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames with no copay, up to a combined maximum of $350 every year. Routine eye exams have no copay and are covered once per year.
Dental Services See details
Dental services are covered, with a $1,000 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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 are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under 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 by the Anthem Medicare Advantage (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a 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 by the Anthem Medicare Advantage (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $95, Lab Services have no copay, and Diagnostic Radiological Services have a copay between $50 and $195. 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 the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. However, 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 all of the sub-services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a Meal Benefit 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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