Are adult dental and routine eye care included?

Adult dental care and adult routine eye care are listed as excluded services in this SBC.

What is the monthly premium?

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

Anthem Silver Pathway HMO 5000 Review (2026)

Q: Do I need a referral to see a specialist?

The referenced SBC says a specialist referral is not required. Confirm the current policy and provider network.

Anthem Silver Pathway HMO 5000 Overview

Anthem Silver Pathway HMO 5000 $10 $0 Virtual PCP $0 Select Drugs S03 is a 2026 Individual and Family HMO documented for Georgia and Indiana. For non-IHCP in-network care, the SBC lists a $5,000 individual deductible and $10,000 family deductible, with an out-of-pocket limit of $9,750 per individual and $19,500 per family. Primary care visits are listed at $10 and specialist visits at $70, with the deductible not applying to those visits. Preventive care and certain prescription drugs may be covered before the deductible. Costs differ for Indian Health Care Providers and other provider categories, so review the official SBC and full policy.

$10 primary care visit, $70 specialist visit and select prescription drug benefits under the 2026 SBC; terms vary by provider and drug tier.

Expert Review of Anthem Silver Pathway HMO 5000

This Silver HMO offers defined office-visit copays and prescription drug tiers, but the deductible and annual out-of-pocket limit remain important cost considerations. Routine out-of-network care is generally not covered, and members should check the provider network and Select Drug List before receiving care or filling prescriptions. The documented version is for Georgia/Indiana; confirm that the exact product is available in the member’s area before publishing it as a selectable plan.

Pros

Primary care has a stated $10 in-network copay.
Specialist visits are listed with a $70 copay and no referral requirement.
Preventive care is covered before the deductible under the SBC terms.

Cons

The non-IHCP in-network deductible is $5,000 per individual.
The individual out-of-pocket limit is $9,750 for non-IHCP in-network care.
Routine out-of-network care is generally not covered.

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 Silver Pathway HMO 5000 Features and Benefits

In-network deductible

$5,000 individual / $10,000 family for non-IHCP in-network care.

IHCP and qualifying referrals have different deductible terms.

Out-of-pocket limit

$9,750 individual / $19,500 family for non-IHCP in-network providers.

Premiums, balance-billing charges and non-covered services do not count toward this limit.

Primary care visits

$10 per visit for non-IHCP in-network providers; deductible does not apply.

Virtual care is also listed as available; confirm the applicable service terms.

Specialist visits

$70 per visit for non-IHCP in-network providers; deductible does not apply.

The SBC says a referral is not required. Network rules still apply.

Preventive care

Covered preventive care is listed at no charge for non-IHCP in-network providers.

Services that are diagnostic rather than preventive may have different cost-sharing.

Prescription drugs

The SBC lists multiple drug tiers, including $3 retail Tier 1 prescriptions and select Tier 2 options.

Drug cost-sharing varies by tier and dispensing method. Check the current Select Drug List.

What Anthem Silver Pathway HMO 5000 Does Not Cover (Exclusions)

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

Adult dental care.
Adult routine eye care.
Infertility treatment.
Private-duty nursing.
Long-term care.
Cosmetic surgery.
Bariatric surgery.
Routine care outside the United States.

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

What's missing in Anthem Silver Pathway HMO 5000

Adult routine dental care is excluded under the referenced SBC.
Adult routine eye care is excluded under the referenced SBC; separate coverage must be checked independently.
Review the current Summary of Benefits and Coverage for exclusions, prior authorization requirements and service-specific limitations.

Anthem Silver Pathway HMO 5000 FAQs

What is the deductible for this Anthem Silver plan?

The 2026 Georgia/Indiana SBC lists $5,000 individual and $10,000 family for non-IHCP in-network care. IHCP terms differ.

What is the individual out-of-pocket limit?

The SBC lists $9,750 per individual and $19,500 per family for non-IHCP in-network providers.

How much is a primary care visit?

The SBC lists a $10 copay for non-IHCP in-network primary care visits, with no deductible applied.

Do I need a referral to see a specialist?