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 2025, 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 2025.
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 $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 $350.00 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 $10100.00 (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 $10100.00 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 has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $2 copay at preferred pharmacies and a $0 copay at standard mail pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for low-income subsidy, you may have a reduced premium.
Additional Benefits
The Anthem Medicare Advantage (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays, and no copays for primary care visits. Emergency, hearing, vision, and dental services are included, with copays ranging from $0 to $125 for various services. This plan also provides coverage for ambulance, home health, and other services such as medical equipment and home infusion. There are no copays for preventive services, routine hearing exams, eyewear, and certain dental services, making this a robust plan with a focus on both preventative and specialized care.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $395 copay for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric have no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $395, while observation services have a $395 copay, and outpatient substance abuse services have a $40 copay per session. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Anthem Medicare Advantage (PPO) plan. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location have no copay for up to 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Anthem Medicare Advantage (PPO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $35 copay; all have no coinsurance.
Primary Care See details
The Anthem Medicare Advantage (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $40 copay. The plan also covers mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, along with additional preventive services, and other services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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 exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $2000 every year, while OTC hearing aids are covered with no copay and a maximum of $300 per year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$40 and a maximum plan benefit of $69 every year, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, have no copay, with a combined maximum benefit of $175 every year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay; a $1,500 maximum applies to both in-network and out-of-network services annually. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 Medicare Advantage (PPO) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by Anthem Medicare Advantage (PPO), including Durable Medical Equipment with a 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are covered. Diagnostic Procedures/Tests have a copay ranging from $0 to $160, and Lab Services have no copay. Diagnostic Radiological Services have a copay ranging from $50 to $395, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. This plan requires prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Medicare Advantage (PPO) plan, requiring prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Other 1 services with no copay, but acupuncture, meal benefits, Dual Eligible SNPs, 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. OTC items have a maximum benefit of $35 every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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