A non-government entity
Anthem Medicare Advantage 3 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 3 (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 3 (PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 3 (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 2025.
It's important to know that Anthem Medicare Advantage 3 (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 3 (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 3 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
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:
Sign up for Anthem Medicare Advantage 3 (PPO)
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Drug Coverage
The Anthem Medicare Advantage 3 (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescriptions. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $13 copay at preferred pharmacies and $18 at standard pharmacies, while standard mail order has no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $295 for days 1-6, with no copay for the rest of the stay, while outpatient services range from no copay to $295. Emergency and primary care services are covered with copays ranging from $0 to $125, and preventive services, including an annual physical exam, have no copay. Additional benefits include hearing, vision, and dental services, with hearing exams costing $40 and dental services having a $1,200 annual maximum benefit. The plan also covers home health services with no copay, and offers a $100 quarterly allowance for over-the-counter items. Other services such as ambulance, diagnostic, and therapeutic services are covered with copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For days 1-6 of an inpatient stay, the copay is $295, while days 7-90 have no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $295. Observation Services have a $295 copay, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage 3 (PPO) with a $40 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Medicare Advantage 3 (PPO). Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved and any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Anthem Medicare Advantage 3 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services has a $35 copay; all have no coinsurance.
Primary Care See details
The Anthem Medicare Advantage 3 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay for routine care, and occupational therapy services have a $40 copay. Physician specialist services, mental health specialty services, and physical therapy and speech-language pathology services have a $40 copay. Podiatry Services and Other Health Care Professional services have copays between $0 and $40. Psychiatric services and Opioid Treatment Program Services have a $40 copay. Additional telehealth benefits are covered with no copay.
Preventive Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Personal Emergency Response System (PERS), and Remote Access Technologies have a copay, while services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, 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, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids 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 and eyewear. Eye exams have a copay between $0 and $40, and eyewear has no copay. Upgrades are not covered.
Dental Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers dental services, with a $1,200 annual maximum benefit. Preventive and diagnostic services such as oral exams, dental x-rays, and cleanings have no copay, and other services such as restorative, endodontics, and orthodontics also have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Medicare Advantage 3 (PPO) plan, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 3 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/Medical Supplies, Medical Supplies, and Diabetic Equipment with a 20% coinsurance; Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic, lab, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $295, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 3 (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 covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for certain services, but the specific amount is not detailed in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Medicare Advantage 3 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Anthem Medicare Advantage 3 (PPO) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $100 every three months. Acupuncture, meal benefit, 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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