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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 2025, 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 Virginia. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $80.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $10000.00 (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 $10000.00 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 Veteran (PPO)
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency services have a $110 copay, and primary care visits have no copay. The plan provides additional benefits such as hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Dental services are covered, with no copay for many services and a $2500 annual maximum. The plan also covers home health services with no copay and offers transportation services with no copay for up to 24 one-way trips per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Anthem Veteran (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5, there is a $290 copay, and days 6-90 have no copay. Additional days for Inpatient Hospital-Acute and Psychiatric have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $290, Observation Services with a $290 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Veteran (PPO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services with a $295 copay, and transportation services to a plan-approved health-related location with no copay for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Anthem Veteran (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
The Anthem Veteran (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $45 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $20, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Anthem Veteran (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, and Other Preventive Services, all with no copay. However, some services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), 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, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay and a yearly benefit maximum of $59, Routine Hearing Exams and Fitting/Evaluation for Hearing Aids with no copay, and Prescription Hearing Aids with a yearly benefit maximum of $1000. OTC Hearing Aids are covered with no copay and a yearly benefit maximum of $300. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45 and a maximum plan benefit of $69 every year, while routine eye exams have no copay. Eyewear is covered with no copay, and a combined maximum amount of $200 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; however, upgrades are not covered.
Dental Services See details
Dental services are covered, with no copay for Medicare dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. This plan has a maximum benefit coverage of $2500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Veteran (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Veteran (PPO) plan, with a coinsurance of 20%.
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 include coverage for Diagnostic Procedures/Tests with a copay between $0 and $140, Lab Services with no copay, Diagnostic Radiological Services with a copay between $50 and $290, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Anthem Veteran (PPO) plan with no copay and no coinsurance. However, 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 Veteran (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Veteran (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for over-the-counter items with no copay, up to a maximum of $50 every three months. Acupuncture, meal benefits, 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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