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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 Wisconsin. 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 $75.00. 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 $10000.00 (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 $10000.00 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:
Sign up for Anthem Veteran (PPO)
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for many key services. Members pay a $15 copay for primary care visits, a $45 copay for specialists, and no copay for telehealth services. For hospital stays, inpatient acute and psychiatric services require a $295 copay per day for days one through six and no copay thereafter, while emergency room visits carry a $115 copay. This plan also includes valuable preventive, dental, vision, and hearing benefits to help lower out-of-pocket expenses. Preventive care, routine eye exams, and routine hearing exams feature no copay, with dental diagnostic services also requiring no copay and comprehensive dental covered at a 25% coinsurance up to a $1,000 annual limit. Additionally, there is no copay or coinsurance for home health services, cardiac rehabilitation, or the first 20 days of a skilled nursing facility stay.
Inpatient Hospital See details
Anthem Veteran (PPO) inpatient hospital services are partially covered with no coinsurance, requiring a $295 copay for days 1 through 6 and no copay for days 7 and beyond for both acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Anthem Veteran (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $275 for outpatient hospital services and $275 per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Veteran (PPO) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Veteran (PPO) covers Medicare-covered ground and air ambulance services with a $290.00 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Anthem Veteran (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 limit with a $115 copay and no coinsurance per service.
Primary Care See details
Anthem Veteran (PPO) covers primary care visits for a $15 copay and specialist visits for a $45 copay, with no coinsurance for either service. Physical, occupational, and speech therapies require a $35 copay, mental health services have a $40 copay, and telehealth is available with no copay, all featuring no coinsurance. While chiropractic services are technically covered, routine and other chiropractic sub-services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by Anthem Veteran (PPO) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, diabetes self-management, glaucoma screenings, and memory fitness. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Anthem Veteran (PPO) hearing services include Medicare-covered exams for a $45 copay and no coinsurance, as well as routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Anthem Veteran (PPO) offers partially covered vision services with no deductibles or coinsurance, featuring a $0 copay for routine annual exams and a $0 to $45 copay for other covered exams, though other eye exam services and eyewear upgrades are not covered. Covered eyewear like contacts and eyeglasses has no copay and is subject to a combined annual limit of $200.
Dental Services See details
Dental services are partially covered by the Anthem Veteran (PPO) plan up to a $1,000 annual benefit limit for both in-network and out-of-network care. Diagnostic and preventive services require no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance; however, 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, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Veteran (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Veteran (PPO) covers medical equipment with no copays, though coinsurance and prior authorization requirements vary by item. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Veteran (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests have no coinsurance and copays ranging from $0 to $100, lab services have no copay, and radiological services require a minimum $50 copay for diagnostic scans, a $75 copay for X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Anthem Veteran (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Anthem Veteran (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Veteran (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Veteran (PPO) partially covers other services, providing a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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