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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 2025, 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 2025.
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 $66.00. 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 $40.00 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 4 (PPO) plan has a $40 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $12 copay at a preferred pharmacy and standard mail order has no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Anthem Medicare Advantage 4 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency and urgent care services have copays, while primary care, preventive services, and many outpatient services have no copay. The plan also covers hearing, vision, and dental services, with specific copays and benefits for each. Additional benefits include coverage for ambulance, home health, and skilled nursing facility services, along with medical equipment and diagnostic services. Prescription hearing aids are covered up to $2,000 per year with no copay, and over-the-counter items are covered up to $100 every three months. There are some services that require prior authorization, and some services that are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, you pay a $295 copay for days 1-7, and no copay for days 8-90. Additional days for both services are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $295, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage 4 (PPO) plan. This benefit requires prior authorization and has a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services and no 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 under the Anthem Medicare Advantage 4 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $25 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $30 copay. Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services have a $30 copay. Podiatry Services have a $0-$30 copay, including Routine Foot Care. Other Health Care Professional Services have a $0-$20 copay. Psychiatric Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies, and Personal Emergency Response System, are covered with a $0 copay. Other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $2,000 per year with no copay, while OTC hearing aids are covered with no copay up to $300 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, but upgrades are not covered.
Dental Services See details
The Anthem Medicare Advantage 4 (PPO) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, all with no copay. Other covered services include orthodontics with a $2,500 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 4 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance of 0% to 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $190, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $295, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered under the Anthem Medicare Advantage 4 (PPO) plan 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 not covered by the Anthem Medicare Advantage 4 (PPO) plan. Prior authorization is required for cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Medicare Advantage 4 (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100; services beyond the Medicare-covered days are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with no copay, with a maximum benefit coverage amount of $100 every three months. Acupuncture, meal benefits, 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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