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 Wisconsin. This plan received an overall rating of 4 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 $68.00. 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 $275.00 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 $8950.00 (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 $8950.00 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 features an annual drug deductible of $275. You will enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs across preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies require a copay starting at $10 for a one-month supply. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 25% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. These coinsurance rates apply equally whether you use preferred, standard, or standard mail-order services.
Additional Benefits
Anthem Medicare Advantage 3 (PPO) offers comprehensive medical coverage with affordable copays for everyday care, including a low $5 copay for primary care visits and no copay for telehealth services. Specialist visits and outpatient substance abuse sessions require a $40 copay, while emergency care carries a $130 copay and urgent care is available for a $35 copay. For hospital stays, members pay a daily copay for the first several days of inpatient care and no copay for subsequent days. The plan highlights wellness by providing no copay and no coinsurance for home health services, routine physicals, preventive dental cleanings, and annual routine hearing and vision exams. While durable medical equipment and dialysis services require up to a 20% coinsurance, diabetic supplies and therapeutic shoes are covered with no copay or coinsurance. Additionally, members can access select over-the-counter items with no copay up to a quarterly allowance.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (PPO) partially covers inpatient hospital care with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute hospital stays require a $295 daily copay for days 1 through 7 and no copay thereafter, while psychiatric stays require a $250 daily copay for days 1 through 6 and no copay for additional days.
Outpatient Services See details
Anthem Medicare Advantage 3 (PPO) covers outpatient hospital services with no copay and a 20% coinsurance, and observation services with a copay and 20% coinsurance. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 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 to receive coverage for this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (PPO) covers ground and air ambulance services with a $295.00 copay and no coinsurance, subject to prior authorization. For transportation services, some services are covered, but transportation to plan-approved health-related locations or 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
Anthem Medicare Advantage 3 (PPO) offers primary care physician services with a $5 copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Telehealth benefits have no copay and no coinsurance, physical and occupational therapy carry a $35 copay with no coinsurance, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, remote access technologies, and select screenings. However, supplemental services such as fitness benefits, health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Anthem Medicare Advantage 3 (PPO) hearing services include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to annual limits, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Anthem Medicare Advantage 3 (PPO) provides coverage for one routine eye exam per year with no copay and no coinsurance, up to a $69 maximum annual benefit. Other eye exams and eyewear, including contacts and eyeglasses, are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage 3 (PPO) provides partially covered dental services with no copay and no coinsurance for covered preventive care, which includes routine oral exams, cleanings, dental X-rays, and fluoride treatments. Comprehensive and specialized services, including restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic treatments, 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. Covered 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 under the Anthem Medicare Advantage 3 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Anthem Medicare Advantage 3 (PPO) with no copays, though prior authorization is required for some items. Durable medical equipment features a 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic supplies and therapeutic shoes are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (PPO) covers diagnostic tests with a $0 to $150 copay and no coinsurance, and lab services with no copay and no coinsurance. Covered radiological services require prior authorization and include diagnostic radiology with copays starting at $50 and no coinsurance, outpatient X-rays with a $75 copay, and therapeutic radiology with 20% coinsurance.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage 3 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 3 (PPO) covers cardiac rehabilitation services with no coinsurance and no copay, though only some services are covered in practice as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem Medicare Advantage 3 (PPO) with no coinsurance, featuring 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, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Anthem Medicare Advantage 3 (PPO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $10.00 every three months. Acupuncture and meal benefits are not covered under this plan.
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