A non-government entity
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 2026, 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 2026.
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 $55.00. 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 $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 combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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:
Sign up for Anthem Medicare Advantage 3 (PPO)
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Drug Coverage
The Anthem Medicare Advantage 3 (PPO) plan features a low annual drug deductible of $150. You can save on medication costs with no copay for Tier 1 preferred generics and Tier 6 select care drugs filled at preferred pharmacies or through standard mail order. Tier 2 generic prescriptions are also highly affordable, starting with no copay for standard mail order and a low $7 copay for a one-month supply at preferred pharmacies. For brand-name and specialty medications, the cost-sharing structure transitions to coinsurance. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance at both preferred and standard pharmacies. Specialty drugs in Tier 5 require a 31% coinsurance for a one-month supply, regardless of whether you use a preferred, standard, or standard mail-order pharmacy.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan provides comprehensive coverage for core medical needs, featuring no copay for preventive care and telehealth visits, and a low $10 copay for primary care doctor visits. Specialist visits require a $45 copay, while emergency room visits have a $130 copay, both with no coinsurance. For hospital stays, members pay a $350 daily copay for the first few days of inpatient care and no copay thereafter, with outpatient hospital copays ranging from no copay up to $350. This plan also includes key supplemental benefits, such as routine hearing and annual routine vision exams with no copays, alongside a $2,000 annual allowance for prescription hearing aids. Dental care is covered up to an $1,800 annual maximum, offering diagnostic and preventive services with no copay and comprehensive services with 25% coinsurance. Additionally, members receive a $60 quarterly allowance for over-the-counter items with no copay, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $350 daily copay for the first 7 days of acute stays and the first 6 days of psychiatric stays, with no copay thereafter. This benefit is partially covered, as prior authorization is required and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (PPO) covers ground and air ambulance services with a $265 copay and no coinsurance, requiring prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Anthem Medicare Advantage 3 (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit, with a $130 copay and no coinsurance.
Primary Care See details
Primary care services are covered by Anthem Medicare Advantage 3 (PPO) with a $10 copay and no coinsurance for primary care visits, and no copay and no coinsurance for telehealth. Specialist visits, physical therapy, and mental health services require a $45 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and remote access technologies. This benefit is partially covered, as several supplemental services such as fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
Anthem Medicare Advantage 3 (PPO) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are available with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Anthem Medicare Advantage 3 (PPO) partially covers vision services, offering one routine eye exam per year with no copay and no coinsurance, up to a $69 annual limit. Other eye exams and all eyewear, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage 3 (PPO) partially covers dental services up to a $1,800 annual maximum, offering diagnostic and preventive care with no copay and no coinsurance. Covered comprehensive services require no copay and 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage 3 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and clinical drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Medicare Advantage 3 (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 3 (PPO) covers medical equipment with no copays, though coinsurance and prior authorization may apply depending on the item. Durable medical equipment incurs a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage 3 (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $215 copay for diagnostic tests, while radiological services involve a $90 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 3 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Anthem Medicare Advantage 3 (PPO) with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 3 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, coverage is not provided for additional days beyond the standard 100 days.
Other Services See details
Anthem Medicare Advantage 3 (PPO) partially covers other services, offering Medicare Community Resource Support and over-the-counter (OTC) items with a $60 quarterly allowance at no copay and no coinsurance. Acupuncture and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
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