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 Kentucky. 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 $75.00. 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 copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a copay between $35 and $45, while emergency room visits have a $115 copay. For hospital stays, inpatient acute care requires a $445 copay for the first five days, while outpatient services range from no copay to a $445 copay. This plan also features valuable dental, vision, and hearing benefits, including a $2,000 annual limit for dental care with no copay for preventive services and a 25% coinsurance for comprehensive care. Routine hearing and vision exams feature no copay, with up to $2,000 covered for prescription hearing aids and a $200 annual limit for eyewear. Additionally, beneficiaries pay no copay and no coinsurance for diabetic supplies, while durable medical equipment incurs a 0% to 20% coinsurance with no copay.
Inpatient Hospital See details
Anthem Veteran (PPO) covers inpatient hospital services with no coinsurance, requiring a $445 copay for days 1 through 5 of acute stays and a $415 copay for days 1 through 5 of psychiatric stays, with no copay for additional days. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Veteran (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services, and a $45 copay for outpatient substance abuse sessions. Outpatient hospital services have a copay ranging from no copay to $445, and observation services incur a $445 copay per stay.
Partial Hospitalization See details
Partial hospitalization services are covered by the Anthem Veteran (PPO) plan with a $55 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Veteran (PPO), with ground and air ambulance services requiring a $350 copay and no coinsurance. Some transportation services are covered, but trips to plan-approved health-related locations and any health-related locations are 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 $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with 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, therapy, and mental health services require copayments ranging from $35 to $45 and no coinsurance. Chiropractic services are partially covered under this plan, but routine and other chiropractic sub-services are not covered.
Preventive Services See details
Anthem Veteran (PPO) offers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and select fitness and remote access technologies. However, the benefit is only partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Anthem Veteran (PPO) covers hearing services with no coinsurance, offering no copay for routine exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $45 copay. Prescription hearing aids are partially covered up to $2,000 annually with no copay, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Anthem Veteran (PPO) vision services are partially covered with no coinsurance, though upgrades and other eye exam services are not covered. Covered eye exams carry a $0 to $45 copay up to a $69 annual limit, and covered eyewear has no copay up to a $200 yearly limit.
Dental Services See details
Dental Services are partially covered under the Anthem Veteran (PPO) plan, which features an annual maximum benefit of $2,000 for both in- and out-of-network care. Covered diagnostic and preventive services have no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance; maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Veteran (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Veteran (PPO) plan with no copay and a 20% coinsurance. This benefit helps Medicare beneficiaries manage the costs of essential kidney dialysis treatments.
Medical Equipment See details
Anthem Veteran (PPO) covers medical equipment, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance, with prior authorization required. Prosthetic devices and medical supplies are covered with no copay and a 20% coinsurance, while diabetic supplies and therapeutic shoes are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Veteran (PPO) covers diagnostic services with no coinsurance, featuring a $0 to $100 copay for procedures and no copay for lab services. Radiological services are also covered under the plan, requiring 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
Anthem Veteran (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Veteran (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Veteran (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Veteran (PPO) provides partially covered Other Services with no copay and no coinsurance for covered benefits, which include a $30 quarterly over-the-counter item allowance, chronic illness meal benefits, and Medicare Community Resource Support. Acupuncture is not covered under this benefit.
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