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 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 Wisconsin. This plan received an overall rating of 4 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 $39.00. 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 $120.00 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 has a $120 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay $11 for a preferred generic drug at a preferred pharmacy, or 20% coinsurance for a standard generic drug. For specialty tier drugs, there is no copay.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay depending on the length of stay, while outpatient services have a 20% coinsurance. Many services have a copay, including primary care, specialist visits, and mental health services. The plan also covers preventive services, hearing exams, and vision exams with a copay. Dental services like oral exams and cleanings are covered with no copay, and there are also benefits for home infusion, dialysis, and medical equipment with coinsurance. The plan also has additional benefits such as OTC items, and skilled nursing facilities, with specific copays and coverage limits.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you pay a $250 copay for days 1-6, and no copay for days 7-90. Additional days for both services are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage 3 (PPO) plan, but requires prior authorization. You will pay a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage 3 (PPO) plan. 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 Anthem Medicare Advantage 3 (PPO). Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $90 copay, while Urgently Needed Services has a $35 copay.
Primary Care See details
The Anthem Medicare Advantage 3 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $40 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, while podiatry services have a $0 to $40 copay depending on the service. Additional telehealth benefits have no copay.
Preventive Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers preventive services including an annual physical exam with no copay. Fitness benefits, including memory fitness, and remote access technologies have no copay. Other preventive services, kidney disease education services, and additional preventive services have a copay. The following services are not covered: Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay and prescription hearing aids with a $3,000 maximum benefit, as well as OTC hearing aids with no copay and a $300 maximum benefit. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear. Eyewear coverage includes contact lenses with no copay, while eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay. 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 3 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a copay between $0 and $150, and lab services have no copay. Diagnostic radiological services have a copay of at most $225 with a minimum copay of $50, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-Ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage 3 (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage 3 (PPO), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and copay information can be found in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 3 (PPO) plan. You will have no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $10 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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