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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 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 Virginia. This plan received an overall rating of 3.5 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 $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:
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers affordable healthcare coverage with no copay for primary care visits and a $45 copay for specialist care. For hospital services, members pay a $290 daily copay for days one through five of an inpatient stay, with no copay for additional days, and a $115 copay for emergency room visits. Outpatient services and diagnostic tests are available with no coinsurance and variable copays, while ambulance rides require a $295 copay. Routine dental, vision, and hearing exams are covered with no copays, alongside an annual dental benefit of up to $2,250 and a $200 eyewear allowance. The plan also includes up to 24 one-way transportation trips per year with no copay, as well as a $50 over-the-counter quarterly allowance. Home health care and diabetic supplies are fully covered with no copay or coinsurance, helping veterans manage their daily health needs affordably.
Inpatient Hospital See details
Anthem Veteran (PPO) offers partially covered inpatient hospital acute and psychiatric services with no coinsurance, though prior authorization is required. For Medicare-covered stays, you will pay a $290 daily copay for days 1 through 5 and no copay for days 6 and beyond, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Veteran (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $290, observation services have a $290 copay per stay, and outpatient substance abuse sessions carry a $45 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem Veteran (PPO) plan with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Veteran (PPO) covers ambulance services with a $295 copay and no coinsurance for both ground and air transportation. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Anthem Veteran (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit, each requiring a $115 copay and no coinsurance.
Primary Care See details
Anthem Veteran (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist, psychiatric, and mental health visits require a $45 copay and no coinsurance. Physical and occupational therapies are covered with a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Anthem Veteran (PPO) plan with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and memory fitness. However, several supplemental services are not covered, including health education, personal emergency response systems, weight management programs, and nutritional benefits.
Hearing Services See details
Anthem Veteran (PPO) covers hearing services, featuring a $45 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fittings. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,000 annually, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with no copay and no coinsurance up to $300 per year.
Vision Services See details
Vision services are partially covered by Anthem Veteran (PPO) with no deductibles, no coinsurance, and no copay for one annual routine eye exam and eligible eyewear. Routine eye exams are limited to a $69 maximum per year, eyewear has a $200 annual limit, and other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Veteran (PPO) features partially covered dental services with an annual maximum benefit of $2,250, offering preventive care with no copay and no coinsurance. Other covered dental services, such as restorative care and oral surgery, require no copay and a 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Veteran (PPO) with no copay and no coinsurance, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Veteran (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Veteran (PPO) covers medical equipment with no copays, though prior authorization and coinsurance of 0% to 20% apply to durable medical equipment, and a 20% coinsurance applies to prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under Anthem Veteran (PPO) require prior authorization, offering diagnostic tests with no coinsurance and a $0 to $140 copay, and lab services with no copay. Radiological services feature a $50 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Anthem Veteran (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Anthem Veteran (PPO) plan, as all related sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Veteran (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not needed for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Veteran (PPO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $50 maximum benefit every three months. Acupuncture and meal benefits are not covered.
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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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