Does the plan have out-of-network benefits?

Yes. The POS SBC lists out-of-network benefits, but the deductible and out-of-pocket limits are much higher than the in-network limits.

What is the monthly premium?

The SBC does not state the premium. Request an official quote based on location and eligibility.

Anthem Bronze Essential POS 5500 Review (2026)

Q: Does this plan require a specialist referral?

No. The SBC states that a referral is not required to see a specialist.

Anthem Bronze Essential POS 5500 Overview

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) is a 2026 Individual and Family Point of Service (POS) plan documented in an Indiana Summary of Benefits and Coverage. The in-network deductible is $5,500 per individual and $11,000 per family. The in-network out-of-pocket limit is $10,150 per individual and $20,300 per family. The SBC also lists higher out-of-network deductibles of $16,500 per individual and $33,000 per family, with out-of-network out-of-pocket limits of $27,600 per individual and $55,200 per family. In-network preventive care is covered at no charge, and specialist referrals are not required. The premium is provided separately.

$5,500 individual in-network deductible, preventive care at no charge in-network, and no specialist referral required.

Expert Review of Anthem Bronze Essential POS 5500

This Bronze POS plan provides separate in-network and out-of-network cost-sharing schedules. The out-of-network deductible and out-of-pocket limits are substantially higher, and many services have 40% in-network coinsurance after the deductible. The first three primary care visits have a $50 copay before the deductible, with 40% coinsurance applying afterward under the SBC. Emergency room care has a $500 copay followed by 40% coinsurance. Compare the full costs, provider network, prescription formulary and state availability before enrolling; the cited document is specifically for Indiana.

Pros

In-network preventive care is listed at no charge.
The first three primary care visits have a $50 copay before the deductible.
Specialist referrals are not required under the SBC.

Cons

The in-network individual deductible is $5,500.
Many covered in-network services have 40% coinsurance after the deductible.
Out-of-network deductibles and out-of-pocket limits are substantially higher.

About Elevance Health (Insurer Profile)

Elevance Health

Key Insights

Founded

1944

Elevance Health was established 82 years ago and has built strong credibility over time, backed by its long-standing presence in the market.

Claims Experience

0% CSR, calculated as a 3-year average

Elevance Health settles 0% of all claims it receives.

Network Hospitals

9000+

Elevance Health has a network of 9000+ hospitals, ensuring wide accessibility and convenience for policyholders.

Anthem Bronze Essential POS 5500 Features and Benefits

In-network deductible

$5,500 per individual and $11,000 per family.

The SBC lists separate out-of-network deductibles of $16,500 per individual and $33,000 per family.

In-network out-of-pocket limit

$10,150 per individual and $20,300 per family.

The SBC lists out-of-network limits of $27,600 per individual and $55,200 per family. Premiums and non-covered care are excluded from these limits.

Primary care visits

$50 per visit for the first three visits, with the deductible not applying; then 40% coinsurance in-network.

All office visit copayments count toward the same three-visit limit. Virtual visit benefits are available.

Specialist visits

40% in-network coinsurance after the deductible.

The SBC states that a referral is not required. Virtual specialist visits may be available.

Preventive care

In-network preventive care, screening and immunization are listed at no charge.

Services that are not preventive may have different cost-sharing.

Prescription drugs

The SBC lists 40% coinsurance for Level 1 pharmacy-only prescriptions and 40% for in-network Level 1 through Level 4 prescriptions after the applicable deductible rules.

Out-of-network retail drug costs may be higher. Check the current formulary and full prescription benefit terms.

What Anthem Bronze Essential POS 5500 Does Not Cover (Exclusions)

Conditions or treatments that the policy clearly says it will not cover.

Abortion, except in the circumstances listed in the SBC.
Children’s dental check-ups.
Hearing aids.
Non-emergency care when travelling outside the United States.
Weight-loss programs.
Acupuncture.
Cosmetic surgery.
Infertility treatment.
Routine adult eye care.
Bariatric surgery.
Adult dental care.
Long-term care.
Routine foot care unless medically necessary.

Disclaimer: For illustration purposes only - exact terms are in the policy wording.

What's missing in Anthem Bronze Essential POS 5500

Adult dental care and routine adult eye care are excluded in the cited SBC.
Non-emergency care outside the United States is generally not covered.
Review the current Summary of Benefits and Coverage for exclusions, prior authorization requirements and service-specific limitations.

Anthem Bronze Essential POS 5500 FAQs

What is the deductible for Anthem Bronze Essential POS 5500?

The 2026 Indiana SBC lists an in-network deductible of $5,500 per individual and $11,000 per family.

What is the in-network out-of-pocket limit?

The SBC lists $10,150 per individual and $20,300 per family for in-network providers.

How much are primary care visits?

The first three primary care visits are $50 each before the deductible; after that, the SBC lists 40% coinsurance.

Does this plan require a specialist referral?