A non-government entity
Anthem Grocery (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Grocery (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Grocery (PPO) in 2025, please refer to our full plan details page.
Anthem Grocery (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 Grocery (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 Grocery (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 Grocery (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $295.00 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 $14000.00 (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 $14000.00 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 Grocery (PPO) plan has a $295.00 deductible for prescription drugs. After you meet your deductible, your cost will vary depending on the drug tier and the pharmacy you use. For preferred generic drugs, there is no copay, while standard generic drugs have a 20-25% coinsurance. Preferred brand drugs have a 35% coinsurance, and non-preferred drugs have a 29% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Grocery (PPO) plan offers a wide range of benefits with varying costs. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $0 to $380 depending on the service. Primary care, preventive services, vision, and dental services are also covered, many with no copay. Additional benefits include hearing exams, home health services, and medical equipment, with some services requiring a copay or coinsurance. Diagnostic and radiological services, skilled nursing facilities, and dialysis services are also covered, with copays and coinsurance varying by service. This plan also has coverage for ambulance and transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $380 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $380 copay for days 1-5, and no copay for days 6-90. 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 $380, observation services with a $380 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services have a copay of $30 for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Grocery (PPO) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Grocery (PPO). Both ground and air ambulance services require a $270 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Anthem Grocery (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay. There is no coinsurance for these services.
Primary Care See details
The Anthem Grocery (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual and group sessions. Podiatry services have a copay between $0 and $30, while other health care professionals have a copay between $0 and $20. Psychiatric services have a $30 copay for individual and group sessions, physical therapy and speech-language pathology services have a $30 copay, additional telehealth benefits have no copay, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other covered services include Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, 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 Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, and routine hearing exams with no copay. Fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Anthem Grocery (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, while 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. This plan also covers Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics, all with no copay.
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 Anthem Grocery (PPO), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 0-20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance; however, durable medical equipment for use outside the home is not covered. Diabetic equipment is covered with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Grocery (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $140, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $30 and $380, while Therapeutic Radiological Services have a 20% coinsurance and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Grocery (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 specific services within this benefit are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Grocery (PPO) plan. There is no copay for days 1-20, and the copay is $214 per day for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Under the Anthem Grocery (PPO) plan, Other Services include Over-the-Counter (OTC) Items with no copay, while acupuncture, meal benefits, 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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