A non-government entity
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 2025, 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 2025.
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 $49.00. 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 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 $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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at preferred pharmacies, while standard mail order for preferred generics has no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Medicare Advantage 3 (PPO) plan offers a range of benefits with varying cost-sharing. It covers inpatient hospital stays with a $350 copay for the first few days, and outpatient services with copays up to $350. Primary care visits have no copay, while specialist visits have a $40 copay. This plan also includes coverage for preventive, hearing, vision, and dental services, often with no copay. Ambulance services have a copay, while emergency services have a $125 copay. Additionally, the plan offers coverage for home health services with no copay and covers skilled nursing facility stays with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital-Acute has a $350 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric also has a $350 copay for days 1-6, and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric have no copay. 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 $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay, while Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage 3 (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage 3 (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $35 copay; all have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Medicare Advantage 3 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, and specialist services with a $40 copay. Mental health specialty services and podiatry services have varying copays, and physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits are covered with no copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefits and Remote Access Technologies, are covered, but may have a copay. Other services such as Health Education and Counseling Services are not covered.
Hearing Services See details
Anthem Medicare Advantage 3 (PPO) covers hearing exams with a $40 copay, routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $3,000 per year, and OTC hearing aids with no copay and a maximum benefit of $300 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
The Anthem Medicare Advantage 3 (PPO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay. Eyewear has a combined maximum benefit of $150 every year and includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. 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, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered with no copay. This plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
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 covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage 3 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $160, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $350, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 3 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Medicare Advantage 3 (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 3 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $40 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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