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Anthem Medicare Advantage 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (PPO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 2 (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 Medicare Advantage 2 (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 2 (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 2 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. 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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $215.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
Sign up for Anthem Medicare Advantage 2 (PPO)
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Drug Coverage
The Anthem Medicare Advantage 2 (PPO) plan features an annual drug deductible of $215. Under this plan, you will enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or standard mail order. Additionally, Tier 6 select care drugs are available with no copay across all pharmacy and mail order options. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% coinsurance. If you fill Tier 1 or Tier 2 prescriptions at standard pharmacies, copays range from $5 to $30 depending on the tier and supply.
Additional Benefits
The Anthem Medicare Advantage 2 (PPO) plan offers robust coverage for core medical needs, featuring no copays or coinsurance for primary care visits, telehealth, and annual physical exams. Specialist visits, urgent care, and mental health services require a $35 to $40 copay, while emergency room visits carry a $115 copay. For hospital stays, there is a $395 daily copay for the first few days of inpatient care and no copay for additional days, with outpatient hospital services ranging from no copay up to a $395 copay. Routine dental, vision, and hearing exams are highly accessible with no copays, though annual coverage limits apply, such as a $1,750 maximum for dental services and a 25% coinsurance for comprehensive dental care. Skilled nursing facility stays feature no copay for the first 20 days, and diabetic supplies are fully covered with no copay or coinsurance. Additionally, members can access over-the-counter items with no copay up to a $45 limit every three months, while durable medical equipment carries a 0% to 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage 2 (PPO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, followed by 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 Medicare Advantage 2 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $395, observation services carry a $395 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem Medicare Advantage 2 (PPO) plan with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Medicare Advantage 2 (PPO), which features a $305 copay and no coinsurance for both ground and air ambulance services, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage 2 (PPO) with a $115 copay and no coinsurance, while urgently needed services require 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 Medicare Advantage 2 (PPO) features primary care and telehealth services with no copay and no coinsurance, alongside specialist, mental health, psychiatric, and opioid treatment services for a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay and no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Anthem Medicare Advantage 2 (PPO) provides preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. Additional preventive benefits are only partially covered, as services such as fitness benefits, health education, personal emergency response systems, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Anthem Medicare Advantage 2 (PPO), which covers one routine hearing exam per year with no copay, no coinsurance, and no deductible up to a $59 annual maximum. Fitting evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 2 (PPO) with no coinsurance and no deductible, though other eye exam services and eyewear upgrades are not covered. Routine eye exams and eyewear—including contacts, lenses, and frames—are covered with no copay, up to an annual limit of $69 for exams and a combined $150 for eyewear.
Dental Services See details
Anthem Medicare Advantage 2 (PPO) dental services are partially covered up to a $1,750 annual maximum, with preventive and diagnostic care offered at no copay and no coinsurance. Comprehensive services like restorative and periodontic care are covered with no copay and a 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 2 (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this benefit, covered Part B insulin carries a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Medicare Advantage 2 (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 2 (PPO) covers medical equipment with no copays, though prior authorization and coinsurance may apply. Durable medical equipment carries 0% to 20% coinsurance, prosthetic devices and medical supplies require 20% coinsurance, and diabetic supplies and therapeutic shoes are fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 2 (PPO) covers diagnostic and radiological services, though prior authorization is required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with copays ranging from $0 to $125, while radiological services require a $50 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 2 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 2 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization is required. Some services are covered, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem Medicare Advantage 2 (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 3-day hospital stay is not necessary for admission, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage 2 (PPO), featuring over-the-counter (OTC) items with no copay and no coinsurance up to a $45 maximum benefit every three months. Acupuncture, meal benefits, and other supplemental services under this category are not covered.
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