A non-government entity
Anthem Medicare Advantage 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 2 (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in GA. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage 2 (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 2 (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 2 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $77.00. 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 $500.00 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 $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 2 (PPO)
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Drug Coverage
The Anthem Medicare Advantage 2 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $7 copay at preferred pharmacies, while standard mail order has no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be reduced. This plan offers an enhanced alternative drug benefit.
Additional Benefits
The Anthem Medicare Advantage 2 (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Primary care visits have a low copay, and specialist visits are $35. Preventive services like annual exams have no copay, and hearing, vision, and dental services are covered, including hearing exams, eye exams, and dental cleanings. Additionally, the plan covers ambulance services, home health, and skilled nursing facility stays, each with its own cost structure. This plan also covers home infusion and dialysis services, with varying coinsurance and copayments depending on the service.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered under the Anthem Medicare Advantage 2 (PPO) plan. For days 1-6 of an inpatient hospital stay, there is a $295 copay, and for days 7-90, there is no copay. Additional days and services are covered with no additional copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Anthem Medicare Advantage 2 (PPO) plan. Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $295 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a $35 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage 2 (PPO) plan. This benefit has a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Medicare Advantage 2 (PPO). Ground and Air Ambulance Services have a $290 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by Anthem Medicare Advantage 2 (PPO). Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay, while Urgently Needed Services have a $30 copay; there is no coinsurance for any of these services.
Primary Care See details
The Anthem Medicare Advantage 2 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, and physician specialist services with a $35 copay. Mental health specialty services, including individual and group sessions, have a $35 copay. Podiatry services have a $0 to $35 copay, other health care professional services have a $5 to $20 copay, psychiatric services have a $35 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have no copay, and opioid treatment program services have a $35 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including fitness benefits, with no copay, as well 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 assessments, personal emergency response systems, 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 benefits, 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.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $35 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a $2000 maximum benefit per year, and OTC hearing aids with no copay and a $300 maximum benefit per year. 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 includes coverage for eye exams with a copay between $0 and $35, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, all with no copay, but upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. 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. Orthodontic services have a maximum benefit of $1,750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 2 (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay ranging from $0 to $140 and lab services with no copay. Radiological services are also covered, with diagnostic radiological services having a copay up to $295 and outpatient X-ray services with a $50 copay, while therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Anthem Medicare Advantage 2 (PPO) plan, with no copay and no coinsurance. However, 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 Medicare Advantage 2 (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 2 (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 for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for Anthem Medicare Advantage 2 (PPO) includes Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $50 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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