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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 KY. 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 $44.00. 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 $300.00 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 $6900.00 (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 $6900.00 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) plan features an annual prescription drug deductible of $300. You will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at both preferred and standard pharmacies. For Tier 2 generic drugs, copays start at just $5 for a one-month supply at preferred pharmacies, while standard mail-order fills have no copay. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands carry a 20% coinsurance, Tier 4 non-preferred drugs require 30% coinsurance, and Tier 5 specialty drugs have a 29% coinsurance for a one-month supply. This structure provides clear, predictable cost-sharing for your essential prescription medications.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copays or coinsurance for primary care, telehealth, and routine preventive services. For specialized care, members pay a $40 copay for specialist visits and a $130 copay for emergency room services. Inpatient hospital stays require a $350 daily copay for the first seven days of an acute stay, with no copay required for additional days. The plan also provides generous supplemental benefits, including a $2,500 annual dental allowance with no copay for preventive services and a 25% coinsurance for comprehensive care. Vision and hearing benefits feature no copays for routine exams, alongside a $150 eyewear allowance and up to $3,000 annually for prescription hearing aids. Additionally, members receive a $60 quarterly allowance for over-the-counter items and home health services with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Medicare Advantage 3 (PPO) with no coinsurance, requiring a $350 daily copay for days 1 to 7 of an acute stay and days 1 to 6 of a psychiatric stay, with no copay for additional days. Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $350 (including $350 per stay for observation services), while outpatient substance abuse individual and group sessions carry a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (PPO) covers partial hospitalization services with a $40 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (PPO) covers ground and air ambulance services with a $295 copay and no coinsurance per trip, though prior authorization is required. Routine transportation services to 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 with a $130 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Medicare Advantage 3 (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, psychiatric care, and mental health services require a $40 copay and no coinsurance. Podiatry and other healthcare professional services range from no copay up to a $40 copay with no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage 3 (PPO) with no copays and no coinsurance for covered options like annual physicals, kidney disease education, and remote access technologies. Sub-services that are not covered include health education, fitness benefits, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, bathroom safety devices, and counseling.
Hearing Services See details
Anthem Medicare Advantage 3 (PPO) covers hearing services with a $40 copay and no coinsurance for Medicare-covered exams, while routine exams, fittings, and over-the-counter hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $3,000 annually, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Anthem Medicare Advantage 3 (PPO) partially covers vision services, offering routine eye exams with no copay and no coinsurance up to a $69 annual limit, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 yearly limit, although upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage 3 (PPO) provides partially covered dental services with an annual maximum benefit of $2,500 for both in- and out-of-network care. Preventive services, including exams and cleanings, are available with no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance. Implant services, orthodontics, 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, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
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, though coinsurance costs vary by service. Durable medical equipment requires 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $160 copay. Covered radiological services require prior authorization and include a $50 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 3 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 3 (PPO) offers cardiac rehabilitation benefits with no coinsurance, meaning some services are covered, but standard cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation (with a $35 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem Medicare Advantage 3 (PPO) with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the 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, including a $60 quarterly OTC allowance. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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