Anthem Medicare Advantage (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $350, and observation services have a $350 copay.

Ambulatory Surgical Center (ASC) Services, Outpatient Blood Services, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $0.

Partial Hospitalization See details

Partial Hospitalization is covered by the Anthem Medicare Advantage (PPO) plan with a $40 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Anthem Medicare Advantage (PPO). Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. 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 by the Anthem Medicare Advantage (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $30 copay.

Primary Care See details

The Anthem Medicare Advantage (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $30 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and podiatry services have a $0-$45 copay. Other health care professional services have a copay between $5 and $20, and opioid treatment program services have a $40 copay. Additional telehealth benefits are available with no copay. Routine chiropractic care is not covered.

Preventive Services See details

Preventive services include annual physical exams with no copay, and additional preventive services that may have a copay. This plan also covers kidney disease education services with no copay, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay.

Hearing Services See details

Hearing services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, and OTC hearing aids are covered with no copay. However, prescription hearing aids for the inner and outer ear are not covered.

Vision Services See details

Vision Services includes coverage for eye exams with a copay between $0 and $45, and eyewear with no copay. Eyewear has a combined maximum benefit of $125 per year.

Dental Services See details

Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay, as well as Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery and Orthodontics with no copay. There is a $750 annual maximum for other dental services.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the Anthem Medicare Advantage (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis services are covered by the Anthem Medicare Advantage (PPO) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered by Anthem Medicare Advantage (PPO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies - Non-Medicare benefits with a coinsurance. Diabetic Equipment is covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, and a copay for other services.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $140, and Lab Services with no copay. Diagnostic Radiological Services have a copay between $15 and $350, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.

Home Health Services See details

Home Health Services are covered by Anthem Medicare Advantage (PPO) 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 covered, but there is no information about the cost sharing for these services. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (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 for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services, including acupuncture, over-the-counter items, meal benefits, and more, are not covered by Anthem Medicare Advantage (PPO). No authorization or referrals are required for these additional services.