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 2026, 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 2026.
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 $51.00. 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 a $200.00 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 $10100.00 (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 $10100.00 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) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard mail order services, while preferred retail pharmacies offer copays starting at $3 and $13 respectively. Additionally, Tier 6 select care drugs are highly affordable with no copay across preferred pharmacies, standard pharmacies, and standard mail order. Higher-tier medications require coinsurance instead of copays during the initial coverage phase. Tier 3 preferred brand drugs carry a 20% coinsurance at preferred pharmacies and standard mail order, compared to a 25% coinsurance at standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 30% coinsurance across all available retail and mail-order options.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers robust medical coverage, featuring no copays or coinsurance for primary care visits, annual physicals, and home health services. For hospital stays, there is no coinsurance, though inpatient care requires a $295 daily copay for the first six days, and outpatient hospital services range from no copay up to a $295 copay. Emergency care is covered with a $130 copay, while specialist visits and physical therapy sessions require a $40 copay. This plan also includes valuable dental, vision, and hearing benefits to help manage your everyday health costs. Diagnostic and preventive dental care, routine hearing exams, and eyeglasses or contact lenses up to $250 annually all feature no copays. Additionally, members receive up to $3,000 for prescription hearing aids and a quarterly allowance of $75 for over-the-counter items with no copays or coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and specific sub-services such as non-Medicare-covered stays and acute upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $295, observation services have a $295 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Anthem Medicare Advantage 3 (PPO), offering ground and air ambulance services for a $304 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage 3 (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum plan benefit, each requiring a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage 3 (PPO) covers primary care visits and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $40 copay and no coinsurance. Routine chiropractic care is not covered under this plan, and prior authorization is required for most specialty services.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage 3 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, remote access technologies, and diabetes screenings. Uncovered sub-services include fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Anthem Medicare Advantage 3 (PPO) covers routine hearing exams and fittings with no copay or coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually, excluding inner ear, outer ear, and over-the-ear models, and over-the-counter hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Medicare Advantage 3 (PPO) offers partially covered vision services with no deductibles and no coinsurance, though other eye exam services and eyewear upgrades are not covered. Eye exams carry a copay ranging from $0 to $40 up to a $69 yearly limit, while eyeglasses and contact lenses have no copay up to a combined annual limit of $250.
Dental Services See details
Anthem Medicare Advantage 3 (PPO) provides partially covered dental services up to a $1,200 annual maximum for both in-network and out-of-network care. Diagnostic and preventive dental care has no copay and no coinsurance, while covered comprehensive services have no copay and a 25% coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 3 (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage 3 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 3 (PPO) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment and supplies are covered with no copay and no coinsurance, though brand limitations apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage 3 (PPO), featuring no coinsurance and copays ranging from $0 to $150 for diagnostic procedures, while lab services have no copay. Diagnostic radiological services require a minimum $50 copay, outpatient X-rays have a $90 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage 3 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage 3 (PPO) with no coinsurance and require prior authorization, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, carrying copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Anthem Medicare Advantage 3 (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 3 (PPO) partially covers other services, offering Medicare Community Resource Support and Over-the-Counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items are capped at a maximum benefit of $75 every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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