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Anthem Medicare Advantage 4 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 4 (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 4 (PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 4 (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties 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 4 (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 4 (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 4 (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 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 $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:
Sign up for Anthem Medicare Advantage 4 (PPO)
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Drug Coverage
The Anthem Medicare Advantage 4 (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay, while standard generic drugs have a 20-25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Medicare Advantage 4 (PPO) plan offers a range of benefits with varying costs. You'll find no copay for primary care visits, preventive services, routine hearing exams, eyewear, dental services, home health services, and many other services. The plan does have copays for inpatient hospital stays, outpatient services, specialist visits, and other services. Emergency and ambulance services are covered, with copays ranging from $30 to $260. The plan also covers services like hearing exams, vision exams, and medical equipment with no copay for many of those services. However, some services, such as cardiac rehabilitation, additional home health care, and certain types of hearing aids, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $380 for days 1-7 and days 1-5, respectively, and no copay for subsequent days. Additional days for both services are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $380, and observation services have a copay of $380. Ambulatory surgical center services and outpatient blood services have no copay, while individual and group sessions for outpatient substance abuse have a copay of $45.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem Medicare Advantage 4 (PPO) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $260 copay and no coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay and no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services has a $30 copay.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $45 copay. Mental Health Specialty Services have a $45 copay for individual and group sessions. Podiatry Services have a copay that ranges from $0 to $45, and Routine Foot Care is covered. Other Health Care Professional services have a copay that ranges from $0 to $20. Psychiatric Services have a $45 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $45 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $45 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional preventive services. Annual physical exams have no copay, and the plan also covers Fitness Benefit, Personal Emergency Response System (PERS), Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Health Education, In-Home Safety Assessment, 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, and Enhanced Disease Management are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have no copay, while OTC hearing aids have no copay. Prescription hearing aids - inner ear, Prescription hearing aids - outer ear, and Prescription hearing aids - over the ear are not covered.
Vision Services See details
Under the Anthem Medicare Advantage 4 (PPO) plan, vision services include eye exams with a copay of $0-$45, and eyewear with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, up to a combined maximum of $200 per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services, with no copay. Other services such as restorative services, endodontics, and periodontics are also covered with no copay. The plan has a maximum benefit coverage of $1500 per year for both in-network and out-of-network services.
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 the Anthem Medicare Advantage 4 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Anthem Medicare Advantage 4 (PPO). Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $380, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 4 (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 not covered by the Anthem Medicare Advantage 4 (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 4 (PPO) plan. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture and several other services are not covered.
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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