A non-government entity
Anthem Medicare Advantage 4 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 4 (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 4 (PPO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 4 (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 4 (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 4 (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 4 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $56.00. 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 $200.00 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 $10200.00 (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 $10200.00 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 4 (PPO) plan features a $200 annual drug deductible, but offers affordable options for generic and select care drugs. For Tier 1 preferred generics and Tier 2 generics, you can save money by using standard mail order, which has no copay for up to a three-month supply. Additionally, Tier 6 select care drugs have no copay across preferred pharmacies, standard pharmacies, and standard mail order. For brand-name and specialty medications, costs transition to coinsurance percentages instead of flat copays. Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies and standard mail order, or 25% at standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 30% coinsurance across all pharmacy options, with specialty drugs limited to a one-month supply.
Additional Benefits
The Anthem Medicare Advantage 4 (PPO) plan offers robust medical coverage with predictable cost-sharing, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a daily copay of $295 for the first few days and no copay thereafter, with no coinsurance required. Emergency room visits carry a $115 copay, while urgent care services are available with a low $25 copay and no coinsurance. This plan also includes strong supplemental benefits, offering routine hearing and vision exams with no copay, alongside annual allowances of $250 for eyewear and up to $2,000 for prescription hearing aids. Preventive dental care features no copay and no coinsurance, while comprehensive dental services require a 25% coinsurance up to a $2,250 annual limit. Additionally, members benefit from a $100 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Anthem Medicare Advantage 4 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, you pay a $295 daily copay for days 1-8 and no copay for additional days, while psychiatric stays require a $295 daily copay for days 1-7 and no copay thereafter. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage 4 (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $295 for outpatient hospital and observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem Medicare Advantage 4 (PPO) with a $40.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Anthem Medicare Advantage 4 (PPO) plan, with ground and air ambulance services requiring a $284.00 copay and no coinsurance. Prior authorization is required for ambulance services, and additional transportation services to health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage 4 (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $100,000 maximum benefit with a $115 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage 4 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialists, therapy, psychiatric, and mental health services require a $30 copay and no coinsurance. Chiropractic services have a $15 copay and no coinsurance, though routine chiropractic care is not covered, and podiatry costs range from a $0 to $30 copay with no coinsurance.
Preventive Services See details
Preventive services under the Anthem Medicare Advantage 4 (PPO) plan are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered, as remote access technologies are included, but fitness benefits, health education, personal emergency response systems, weight management, and home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage 4 (PPO), featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and OTC hearing aids. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, excluding inner ear, outer ear, and over the ear hearing aids.
Vision Services See details
Anthem Medicare Advantage 4 (PPO) offers partially covered vision services with no coinsurance, featuring a $0 to $30 copay for eye exams and no copay for covered eyewear up to a $250 annual limit. Routine eye exams are covered with no copay (one per year, up to $69), but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage 4 (PPO) partially covers dental services up to a $2,250 annual limit, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and a 25% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 4 (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this plan, Medicare Part B chemotherapy and other infusion drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage 4 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 4 (PPO) covers durable medical equipment with no copay and 0% to 20% coinsurance, while prosthetics and medical supplies are covered with no copay and a 20% coinsurance. Diabetic equipment and supplies, including therapeutic shoes or inserts, are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 4 (PPO) covers diagnostic and radiological services, featuring no copay or coinsurance for lab services and a $0 to $190 copay with no coinsurance for diagnostic tests. Diagnostic radiological services require a copay starting at $50, outpatient X-rays have a $90 copay, and therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required.
Home Health Services See details
Home Health Services are covered under the Anthem Medicare Advantage 4 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 4 (PPO) covers some cardiac rehabilitation services with no copayment and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem Medicare Advantage 4 (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, and no prior three-day hospital stay is needed, though additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Anthem Medicare Advantage 4 (PPO) partially covers other services, offering no copay and no coinsurance for Medicare Community Resource Support and Over-the-Counter (OTC) items up to a $100 limit every three months. However, acupuncture, meal benefits, and other additional services are not covered under this plan.
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