A non-government entity
Anthem Medicare Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (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 (PPO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Kentucky. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. 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 $250.00 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:
Sign up for Anthem Medicare Advantage (PPO)
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Drug Coverage
The Anthem Medicare Advantage (PPO) plan features a $250 drug deductible before coverage begins for certain tiers. You will enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs at both preferred and standard pharmacies, as well as through standard mail order. Tier 2 generic prescriptions also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies require a copay starting at $10 for a one-month supply. For higher-tier medications, your costs are based on a coinsurance percentage rather than a flat copayment. Tier 3 preferred brand drugs require a 25% coinsurance, whereas Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance. These coinsurance rates apply across preferred pharmacies, standard pharmacies, and standard mail-order services.
Additional Benefits
The Anthem Medicare Advantage (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, home health services, and preventive care. For hospital stays, members pay a $550 daily copay for the first four days of acute inpatient care, with no copay for additional days. Emergency care is covered with a $115 copay, and urgent care visits require a $35 copay, both with no coinsurance. Ancillary benefits include dental coverage up to a $1,500 annual maximum, featuring no copay for preventive services and a 25% coinsurance for comprehensive care. Hearing and vision benefits provide routine exams with no copay, alongside annual allowances of up to $2,000 for prescription hearing aids and $250 for eyewear. Additionally, diabetic supplies are fully covered with no copay or coinsurance, while durable medical equipment carries a 0% to 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (PPO) partially covers inpatient hospital services, excluding room upgrades and non-Medicare-covered stays, with no coinsurance and prior authorization required. For acute inpatient stays, there is a $550 daily copay for days 1 through 4 and no copay for days 5 and beyond, while psychiatric stays require a $520 daily copay for days 1 through 4 and no copay thereafter.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage (PPO) with no coinsurance across all categories, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0.00 to $550.00 (with a $550.00 copay per stay for observation services), while individual and group outpatient substance abuse sessions have a $40.00 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (PPO) covers ground and air ambulance services with a $295 copay and no coinsurance, subject to prior authorization. Transportation services are not covered, including trips to plan-approved and any health-related locations.
Emergency Services See details
Anthem Medicare Advantage (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit, with a $115 copay and no coinsurance for each service.
Primary Care See details
Anthem Medicare Advantage (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $40 copay with no coinsurance. Physical, occupational, and speech therapies have a $35 copay with no coinsurance, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Anthem Medicare Advantage (PPO) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, remote access technologies, and glaucoma screenings. However, many additional preventive benefits are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems (PERS), and nutritional services.
Hearing Services See details
Anthem Medicare Advantage (PPO) covers hearing services with no deductible, offering routine exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription and OTC hearing aids are covered with no copay or coinsurance up to annual limits of $2,000 and $300 respectively, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Anthem Medicare Advantage (PPO) partially covers vision services, offering eye exams with a $0 to $40 copay and no coinsurance up to a $69 annual limit, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $250 annual limit, but upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (PPO) offers partially covered dental services with an annual maximum benefit of $1,500 for both in- and out-of-network care. Preventive and diagnostic services feature no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with a 0% to 20% coinsurance.
Dialysis Services See details
Anthem Medicare Advantage (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (PPO) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics and medical supplies. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, though select benefits may require prior authorization.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (PPO) covers diagnostic and radiological services with no coinsurance and a $0 to $125 copay for diagnostic tests, and no copay for lab services. Outpatient X-rays and diagnostic radiology services require a $50 copay, while therapeutic radiology services carry a minimum 20% coinsurance.
Home Health Services See details
Anthem Medicare Advantage (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (PPO) offers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the standard 100-day limit are not covered. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Other Services are partially covered by Anthem Medicare Advantage (PPO), which offers Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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