A non-government entity
Anthem Medicare Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (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 (PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in State of New Hampshire. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $395.00 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 $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 Medicare Advantage (PPO)
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Drug Coverage
The Anthem Medicare Advantage (PPO) plan has a $395.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you may pay a $10.00 copay for preferred generic drugs at a preferred pharmacy, or 20% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $415 copay for days 1-4, and then no copay for the rest of the stay, and outpatient services have copays or coinsurance between 0% and 25%. The plan also covers primary care visits with a $10 copay, hearing exams with a $35 copay, and eye exams with a copay between $0 and $35. Preventive services, such as annual physical exams, have no copay, along with many dental and vision services. The plan also includes coverage for ambulance services with a $300 copay for ground transport and 20% coinsurance for air transport, and a $1,500 annual maximum benefit for dental services. Home health services, durable medical equipment, and many other services are covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital stays, including acute and psychiatric, are covered by Anthem Medicare Advantage (PPO) with a copay of $415 for days 1-4, and no copay for days 5-90. Additional days for both acute and psychiatric stays are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 25% coinsurance and no copay, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance and no copay, and Outpatient Blood Services with no copay. Outpatient Substance Abuse Services are covered, including Individual and Group Sessions, both with a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (PPO) plan, but requires prior authorization. The copay for this benefit is $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Medicare Advantage (PPO). Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Medicare Advantage (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance; however, Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, Other Health Care Professional services with a copay between $10 and $20, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services including fitness benefits and remote access technologies, both of which have no copay. Other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit also have no copay. Several preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more.
Hearing Services See details
Hearing Services are partially covered by Anthem Medicare Advantage (PPO). Hearing exams have a $35 copay, but routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $35, and eyewear with no copay, including eyeglasses and contact lenses. Upgrades are not covered, and there is a $69 maximum benefit amount for eye exams and a $125 combined maximum benefit amount for eyewear.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. 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 are covered with no copay, while Medicare Dental Services and Orthodontic Services also have no copay.
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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (PPO). The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies and Diabetic Equipment, both with no copay and 20% coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay ranging from $0 to $85, and lab services have no copay. Diagnostic Radiological Services have a copay up to $250, and outpatient X-ray services have a $65 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (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 the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (PPO), but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which have no copay, with a maximum plan benefit coverage amount of $70 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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