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Anthem Medicare Advantage 3 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 3 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Medicare Advantage 3 (PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 3 (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage 3 (PPO) 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 3 (PPO).
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 3 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $62.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $60.00 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 combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
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Drug Coverage
The Anthem Medicare Advantage 3 (PPO) plan has a $60.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $7.00 copay at a preferred pharmacy, or $12.00 at a standard pharmacy. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay coinsurance. The plan offers no copay for specialty tier drugs, and no copay for preferred mail order generic drugs.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for days 1-7 and no copay for subsequent days. Outpatient services have copays ranging from $0 to $350, and emergency services have a $125 copay. Primary care visits cost $10, and specialist visits cost $40. Preventive services, including an annual physical exam, have no copay. Hearing exams have a $40 copay, and prescription hearing aids are covered up to $3,000 per year. Vision services include eye exams with a copay between $0 and $40. Dental services cover oral exams and cleanings with no copay, but only once per year. Other benefits include home health services with no copay, and over-the-counter items covered up to $60 every three months.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $350 for days 1-7, and no copay for days 8-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $40 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage 3 (PPO) with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers ambulance services, with a $265 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 3 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $35 copay; all have no coinsurance.
Primary Care See details
The Anthem Medicare Advantage 3 (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, and physician specialist services with a $40 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Podiatry services have varying copays, with routine foot care having no copay. Other health care professionals have a copay between $10 and $20, while psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits are covered with no copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are also covered, as are kidney disease education services. Other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing exams have a $40 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids are covered with a maximum benefit of $3,000 per year, and OTC hearing aids have no copay with a maximum benefit of $300 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay ranging from $0 to $40 and eyewear with no copay, but contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams have a $0 copay.
Dental Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers oral exams and prophylaxis (cleaning) with no copay, but only allows one oral exam and one cleaning per year. Dental X-Rays and Fluoride Treatment are optional supplemental benefits, so you may have to pay more for access to these benefits. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Medicare Advantage 3 (PPO) 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 under the Anthem Medicare Advantage 3 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with no copay and 0-20% coinsurance, and prosthetic devices and medical supplies with 20% coinsurance. Diabetic equipment is covered, including diabetic supplies and therapeutic shoes/inserts 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. Diagnostic Procedures/Tests have a copay between $0 and $215, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 3 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage 3 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 3 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers over-the-counter (OTC) items with no copay, up to a maximum of $60 every three months. Other services such as acupuncture, meal benefits, and various other services are not covered.
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