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 2026, 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 2026.
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 $82.00. 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 $750.00 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 $13900.00 (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 $13900.00 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
The Anthem Medicare Advantage 2 (PPO) plan features an annual drug deductible of $200. Under this plan, you will enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or standard mail order. Additionally, Tier 6 select care drugs are available with no copay at both preferred and standard pharmacies, as well as through standard mail order. For brand-name and specialty medications, costs are structured as coinsurance, including a 25% coinsurance for Tier 3 preferred brands and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 30% coinsurance for a one-month supply across all pharmacy types. If you choose to fill Tier 1 or Tier 2 generic prescriptions at a standard pharmacy, copays range from $5 to $30 depending on the drug tier and supply duration.
Additional Benefits
The Anthem Medicare Advantage 2 (PPO) plan offers robust coverage with predictable costs, featuring no coinsurance for many primary medical services. You will pay a low $10 copay for primary care visits, a $45 copay for specialists, and no copay for telehealth services. Inpatient hospital stays require a $295 daily copay for the first six days and no copay thereafter, while emergency room visits incur a flat $115 copay. For ancillary care, the plan provides preventive dental, routine vision, and routine hearing exams with no copay, alongside annual allowances for hearing aids and eyewear. While home health services and diabetic supplies are fully covered with no copay or coinsurance, other services like dialysis and durable medical equipment require up to a 20% coinsurance. However, it is important to note that this plan does not cover certain extra benefits such as routine transportation, acupuncture, meals, or over-the-counter items.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 to 6 and no copay for days 7 and beyond. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Anthem Medicare Advantage 2 (PPO) covers outpatient services with no coinsurance for all covered care. Patients will pay no copay for ambulatory surgical center and blood services, a $0 to $295 copay for outpatient hospital services, a $295 copay per stay for observation services, and a $45 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage 2 (PPO) with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Anthem Medicare Advantage 2 (PPO), which offers ground and air ambulance services for a $260 copay and no coinsurance, requiring 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 2 (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Medicare Advantage 2 (PPO) covers primary care visits for a $10 copay and specialists for a $45 copay, both with no coinsurance, while telehealth services are available with no copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay, mental health and psychiatric services have a $45 copay, and podiatry ranges from a $0 to $45 copay, all with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage 2 (PPO) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and remote access technologies. However, several additional preventive benefits are not covered, including 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, palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, disease management, telemonitoring, home safety modifications, and counseling. Covered screenings and training, such as glaucoma and diabetes self-management, are also available with no copay and no coinsurance.
Hearing Services See details
Anthem Medicare Advantage 2 (PPO) covers routine hearing exams and evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Hearing aids are covered with no copay and no coinsurance up to annual limits of $2,000 for prescription and $300 for over-the-counter devices, though prescription hearing aids are partially covered as inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 2 (PPO), offering eye exams with a $0 to $45 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $250 annual limit. One routine eye exam is covered per year with no copay, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage 2 (PPO) with an annual maximum benefit of $1,500 for both in- and out-of-network care. Preventive services like cleanings and exams have no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 2 (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage 2 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (PPO) covers medical equipment, offering durable medical equipment with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes or inserts, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 2 (PPO) covers diagnostic services with no coinsurance, offering a $0 to $140 copay for procedures and tests and no copay for lab services. Covered radiological services include outpatient X-rays with a $50 copay, diagnostic radiology with a minimum $50 copay, and therapeutic radiology with a minimum 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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Anthem Medicare Advantage 2 (PPO) with no coinsurance and require prior authorization. While some services are covered, specific programs like standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 2 (PPO) with no coinsurance, requiring prior authorization and 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 Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the Anthem Medicare Advantage 2 (PPO) plan, which excludes acupuncture, meal benefits, and over-the-counter (OTC) items from coverage.
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