Anthem Prime (HMO-POS)
The Anthem Prime (HMO-POS) is a 2026 HMO-POS Medicare Advantage plan from Anthem Blue Cross Partnership Plan with a $0 monthly premium and a 3-star CMS rating. It may include allowances for vision, hearing, and otc / flex allowance. It's available in 1 county across 1 state.
Reviewed by the Medicare Advocates team · 2026 plan year · sourced from CMS data
Offered in 1 county across 1 state
- Monthly premium$0
- Overall star rating3 / 5
- In-network max out-of-pocket$800
- Vision$300
- Hearing$3,000
- OTC / Flex allowance$152
2026 plan-year figures (premium, star rating, MOOP) from the CMS Landscape file; allowance amounts from CMS PBP data. Amounts vary by plan; not all plans offer all benefits.
What the Anthem Prime (HMO-POS) plan may include
- Vision: up to $300 per year in plan allowance (2026).
- Hearing: up to $3,000 per year in plan allowance (2026).
- OTC / Flex allowance: up to $152 per year in plan allowance (2026).
Costs & coverage detail
Annual Part D drug deductible: $0 (2026).
Doctor visits
- Primary care visit$0
- Specialist visit$0
Emergency & urgent care
- Emergency room$150 copay
- Urgent care$25 copay
Tests, labs & imaging
- Lab services$0
- Diagnostic tests & procedures$0
- X-rays$0
- Diagnostic radiology (CT/MRI/PET)$0–$50 copay
Outpatient hospital & surgery
- Outpatient hospital services$0
- Ambulatory surgical center$0
- Outpatient substance abuse (individual)$25 copay
Home health & equipment
- Home health care$0
Medical equipment & supplies
- Durable medical equipment (DME)0–20% coinsurance
Ambulance
- Ground ambulance$200 copay
Dental
- Preventive dental (exams, cleanings, X-rays)$0
- Comprehensive dental (restorative)25% coinsurance
Vision
- Routine eye exam$0
- Eyewear (glasses/contacts)$0
Hearing
- Routine hearing exam$0
- Hearing aids$0
Hospital stays
- Skilled nursing facility (SNF)$0/day, days 1–20; $218/day, days 21–100
In-network, Medicare-covered cost sharing for the 2026 plan year (CMS PBP data). Costs vary by service and setting; see the Summary of Benefits for full detail.
Extra benefit allowances
- Eyewear allowance$300 per year
- Hearing aid allowance$3,000 per year
- Over-the-counter (OTC) allowance$38 per quarter
Prescription drug costs
Annual Part D drug deductible: $0.
| Tier | Preferred retail | Standard retail | Mail (90-day) |
|---|---|---|---|
| Tier 1 · Preferred Generic | $0 | $0 | — |
| Tier 2 · Generic | $0 | $0 | — |
| Tier 3 · Preferred Brand | $42 | $47 | — |
| Tier 4 · Non-Preferred Drug | 25% | 25% | — |
| Tier 5 · Specialty Tier | 33% | 33% | — |
30-day supply cost share for the 2026 plan year, in-network (mail column shows 90-day). Amounts shown are before any deductible applies and vary by drug.
Preventive services
This plan covers $0 for all preventive services covered under Original Medicare when you use an in-network provider — including annual wellness visits, recommended screenings, and vaccines.
Common questions
- What is the Anthem Prime (HMO-POS) plan?
- It is a Medicare Advantage plan (CMS plan ID H4161-010-000) offered by Anthem Blue Cross Partnership Plan for the 2026 plan year. Medicare Advantage plans bundle your Part A and Part B coverage, and most include extra benefits Original Medicare does not.
- What extra benefits could this plan include?
- Depending on the plan, supplemental benefits may include allowances toward vision, hearing, otc / flex allowance. Amounts shown are for the 2026 plan year and vary by plan and area. A licensed agent can confirm what is available to you.
- Where is this plan available?
- For 2026, this plan is offered in 1 county across 1 state. Availability and benefits depend on your specific ZIP code.
- How do I enroll or compare plans?
- Call to speak with a licensed insurance agent who can review this plan alongside the other options in your area at no cost. There is no obligation to enroll, and enrollment may be limited to certain times of year unless you qualify for a Special Enrollment Period.
Counties served
California (1 county)
Santa Clara
Plan documents
Official 2026 documents for this plan:
Ready when you are.
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