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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 2025, 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 Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $95.00. 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:
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays. It also includes coverage for emergency services, primary care, preventive services, vision, hearing, and dental services, often with no copay or a low copay. Additionally, this plan covers home health services, medical equipment, and diagnostic services, with some services requiring coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-6, there is a $295 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient services are covered under the Anthem Veteran (PPO) plan, including outpatient hospital services with a copay of $0 to $275, observation services with a $275 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Veteran (PPO) plan. There is a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $290 copay for both ground and air ambulance services, and no coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Veteran (PPO) plan. Emergency Services has a $90 copay, and Urgently Needed Services has a $25 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay, and the maximum plan benefit coverage is $100,000.
Primary Care See details
The Anthem Veteran (PPO) plan covers primary care physician services and chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $45 copay. Mental health specialty services and podiatry services have a copay that ranges from $0 to $45, while other health care professional visits have a copay between $15 and $20. Psychiatric services and opioid treatment program services have a $40 copay, physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and also covers additional preventive services with a copay, as well as other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, 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, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, Routine Hearing Exams with no copay, Fitting/Evaluation for Hearing Aid with no copay, Prescription Hearing Aids (all types) with no copay, and OTC Hearing Aids with no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with no copay, and upgrades are covered as well.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics with no copay. The plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Veteran (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits include coverage for durable medical equipment with 0% to 20% coinsurance, prosthetics and medical supplies with 20% coinsurance, and diabetic equipment with no copay for diabetic supplies and diabetic therapeutic shoes or inserts. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem Veteran (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $100, while Lab Services have no copay. Diagnostic Radiological Services have a minimum copay of $50 and a maximum copay of $275, while 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 the Anthem Veteran (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 Veteran (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Veteran (PPO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $203.
Other Services See details
The Anthem Veteran (PPO) plan covers over-the-counter items and meal benefits with no copay, and also covers other services with no copay. Acupuncture, 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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