A non-government entity
Anthem Veteran (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Veteran (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Veteran (PPO) in 2026, please refer to our full plan details page.
Anthem Veteran (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in OH. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Anthem Veteran (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Veteran (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 Veteran (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $165.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers robust coverage with predictable out-of-pocket costs, featuring no coinsurance for most medical services and no copays for primary care visits, preventive care, and home health services. For specialized care, members pay a $40 copay for specialist visits and a $350 copay for days 1 through 5 of inpatient hospital stays, with no copay for days 6 and beyond. Emergency room visits require a $130 copay, while urgent care visits carry a low $25 copay. This plan also includes valuable supplemental benefits like routine dental, vision, and hearing exams with no copays. Members receive a $2,000 annual dental maximum and a $225 annual eyewear allowance to help cover key personal care costs. Additionally, the plan provides a $130 quarterly over-the-counter allowance and up to 60 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Anthem Veteran (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 copayment for days 1 through 5 and no copayment for days 6 and beyond for Medicare-covered acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem Veteran (PPO) covers outpatient services with no coinsurance for all benefits, including ambulatory surgical center and outpatient blood services which also feature no copays. Outpatient hospital services carry a copay ranging from $0 to $350, observation services require a $350 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Veteran (PPO) with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Anthem Veteran (PPO) plan, with Medicare-covered ground and air ambulance services requiring a $280 copay and no coinsurance. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem Veteran (PPO) covers emergency services with a $130 copay and no coinsurance, and urgent care services with a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Veteran (PPO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist, therapy, mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance. Podiatry services range from a $0 to $40 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Anthem Veteran (PPO) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copays and no coinsurance. Additional preventive benefits are partially covered with no copays or coinsurance for select services like memory fitness, remote access, and home safety modifications (up to $500 annually), while services like health education, weight management, and in-home support are not covered.
Hearing Services See details
Anthem Veteran (PPO) covers hearing services with no coinsurance, requiring a $40 copay for Medicare-covered exams and no copay for routine annual exams, fittings, and over-the-counter hearing aids. Prescription hearing aids are partially covered with no copay up to a $3,000 annual limit, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Anthem Veteran (PPO), offering eye exams with a $0 to $40 copay and eyewear with no copay, both with no deductibles or coinsurance. While one routine eye exam per year and eyewear (up to $225 annually) are covered with no copay, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Veteran (PPO) dental services feature a $2,000 annual maximum benefit for both in-network and out-of-network care, covering preventive services with no copay and no coinsurance. Comprehensive services are partially covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Veteran (PPO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs are covered with a 0% to 20% coinsurance and no copay, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Anthem Veteran (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Veteran (PPO) covers medical equipment, including durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Veteran (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance, and diagnostic procedures with a $0 to $100 copay. Radiological services require a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Anthem Veteran (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Anthem Veteran (PPO) plan with no coinsurance, though prior authorization is required. Covered services require a $15 copay for pulmonary rehabilitation and a $20 copay for cardiac rehabilitation, intensive cardiac rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem Veteran (PPO) with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and prior authorization is required, though additional days beyond the Medicare limit are not covered.
Other Services See details
Other services are partially covered by Anthem Veteran (PPO) with no copay and no coinsurance, which includes a $130 quarterly over-the-counter allowance, chronic illness meal benefits, and Medicare Community Resource Support. Acupuncture is not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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