A non-government entity
Anthem Medicare Advantage 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (PPO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 2 (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living 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 2 (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 2 (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 2 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 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:
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Drug Coverage
The Anthem Medicare Advantage 2 (PPO) plan features a $250 drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at both preferred and standard pharmacies. Tier 2 generic drugs are also highly affordable, starting at a $3 copay for a one-month supply at preferred pharmacies and offering no copay through standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance. These coinsurance rates apply consistently across preferred pharmacies, standard pharmacies, and standard mail order options.
Additional Benefits
Anthem Medicare Advantage 2 (PPO) offers comprehensive healthcare coverage with no copay and no coinsurance for primary care, telehealth, and routine preventive services. For specialized medical needs, members pay a $40 copay for specialist visits and a $130 copay for emergency services, while inpatient hospital stays require a $370 daily copay for the first five days. Outpatient services, diagnostic lab tests, and home health care are also covered, often with no copay and no coinsurance. This plan provides valuable supplemental benefits, including routine dental, vision, and hearing exams with no copay or coinsurance. Dental benefits feature a $1,500 annual limit with a 25% coinsurance for comprehensive care, while eyewear and prescription hearing aids are covered up to $200 and $2,000 annual limits, respectively. Additionally, medical equipment and dialysis services are covered, though they may require up to a 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (PPO) partially covers inpatient hospital services with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Covered acute and psychiatric stays require prior authorization and a $370 daily copay for days 1 through 5, followed by no copay for days 6 and beyond, including unlimited additional days.
Outpatient Services See details
Anthem Medicare Advantage 2 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay between $0 and $370, observation services carry a $370 copay per stay, and individual or group outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage 2 (PPO) with a $40 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Anthem Medicare Advantage 2 (PPO), with ground and air ambulance services requiring prior authorization, a $275 copay, and no coinsurance. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Anthem Medicare Advantage 2 (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 limit, with a $130 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage 2 (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, and mental health services require a $40 copay and no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Anthem Medicare Advantage 2 (PPO) preventive services are partially covered with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and remote access technologies. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Anthem Medicare Advantage 2 (PPO) covers routine hearing exams and fitting evaluations with no copay or coinsurance, whereas Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, excluding inner ear, outer ear, and over-the-ear models, while OTC hearing aids are covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 2 (PPO), featuring no copay and no coinsurance for one routine annual eye exam and eyewear up to a $200 annual limit. Other eye exam services and eyewear upgrades are not covered, and non-routine eye exams may require a copay of up to $40 with no coinsurance.
Dental Services See details
Anthem Medicare Advantage 2 (PPO) partially covers dental services up to a $1,500 annual limit, offering preventive care with no copay and no coinsurance. Comprehensive dental services are covered with no copay and a 25% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 2 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage 2 (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (PPO) covers medical equipment with no copays, though coinsurance of 0% to 20% applies to durable medical equipment and 20% coinsurance applies to prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are covered with no copays and no coinsurance, though prior authorization or manufacturer limitations may apply to certain items.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 2 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests range from a $0 to $160 copay with no coinsurance, lab services have no copay, and radiological services require a $50 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 2 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage 2 (PPO) with no copay and no coinsurance, although prior authorization is required. In practice, some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 2 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Anthem Medicare Advantage 2 (PPO) provides partial coverage for other services, featuring Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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