A non-government entity
Anthem Veteran (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Veteran (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Veteran (PPO) in 2026, please refer to our full plan details page.
Anthem Veteran (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in GA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Anthem Veteran (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Veteran (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 Veteran (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. Additionally, this plan comes with a Part B Premium reduction of $155.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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:
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers comprehensive medical coverage with no coinsurance for primary care visits, which carry a $20 copay, and specialist visits at a $50 copay. Preventive care, telehealth, and home health services are available with no copay, while emergency room visits require a $115 copay. Inpatient hospital stays feature a $375 daily copay for the first several days of your stay and no copay for any additional days. For supplemental care, the plan features dental coverage with no copay for preventive services and a 25% coinsurance for comprehensive services up to a $2,000 annual limit. Routine vision and hearing exams are covered with no copay, and the plan provides up to $200 annually for eyewear. Durable medical equipment, dialysis, and Part B drugs generally require a 0% to 20% coinsurance with no copay.
Inpatient Hospital See details
Anthem Veteran (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for additional days. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Veteran (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay and no coinsurance. Outpatient hospital services have a $0 to $375 copay, observation services carry a $375 copay per stay, and outpatient substance abuse sessions require a $50 copay, all with no coinsurance.
Partial Hospitalization See details
Anthem Veteran (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Veteran (PPO) covers ground and air ambulance services with a $288.00 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Veteran (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Veteran (PPO) covers primary care visits for a $20 copay and specialist visits for a $50 copay, both with no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, telehealth has no copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Anthem Veteran (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. This benefit is partially covered, as supplemental services such as health education, in-home safety assessments, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Anthem Veteran (PPO) covers one routine hearing exam per year with no copay, no coinsurance, and no deductible, up to a $59 maximum annual benefit. Hearing aid fittings, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Anthem Veteran (PPO) with no deductibles, no coinsurance, and no copay for one routine eye exam per year up to $69 and eyewear up to a $200 annual limit. Other eye exams and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Anthem Veteran (PPO) plan, which features a $2,000 annual maximum and offers preventive care with no copay and no coinsurance. Covered comprehensive services require no copay and 25% coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Anthem Veteran (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Veteran (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Veteran (PPO) covers medical equipment with no copays, though coinsurance and prior authorization requirements vary by item. Durable medical equipment has a 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
Diagnostic and radiological services are covered by Anthem Veteran (PPO), offering lab services with no copay and no coinsurance, and diagnostic procedures with a $0 to $140 copay and no coinsurance. Diagnostic radiological services and outpatient X-rays require a copay starting at $50, while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Anthem Veteran (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Anthem Veteran (PPO) offers Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though only some services are covered. Specifically, cardiac rehabilitation (with a $25 copay), intensive cardiac rehabilitation (with a $25 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Veteran (PPO) covers skilled nursing facility (SNF) care with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days beyond the Medicare limit not covered.
Other Services See details
Other services are not covered under the Anthem Veteran (PPO) plan, which excludes coverage for acupuncture, over-the-counter (OTC) items, and meal benefits.
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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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