A non-government entity
Anthem Grocery (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Grocery (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Grocery (PPO) in 2025, please refer to our full plan details page.
Anthem Grocery (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 Grocery (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 Grocery (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 Grocery (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.
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 $295.00 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 $11300.00 (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 $11300.00 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
The Anthem Grocery (PPO) plan has a $295 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $3 copay at a preferred pharmacy, $8 at a standard pharmacy, and no copay for standard mail order. For specialty tier drugs, there is no copay.
Additional Benefits
The Anthem Grocery (PPO) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have copays depending on the length of stay, while outpatient services have a range of copays. Emergency services and primary care visits have copays, and preventive services are covered with no copay. This plan also includes coverage for hearing, vision, and dental services, with no copays for many dental services, and a $1,000 annual maximum. Additional benefits include ambulance services with copays, home health services with no copay, and coverage for medical equipment with varying coinsurance. The plan also covers other services such as OTC items with a maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization; Inpatient Hospital-Acute has a copay of $415 for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a copay of $415 for days 1-4, and no copay for days 5-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered. Outpatient hospital services have a copay between $0 and $415, observation services have a $415 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services are covered, with individual and group sessions having a $40 copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Grocery (PPO) plan with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Grocery (PPO), with no coinsurance for any services. Ground and air ambulance services each have a $305 copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Grocery (PPO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The Anthem Grocery (PPO) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. The plan also covers occupational therapy services, physician specialist services with a $45 copay, and mental health specialty services with a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits are available with no copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, including fitness benefits, are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, while routine hearing exams have no copay. Fitting/evaluation for hearing aids and prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $45, and routine eye exams with no copay, but no other eyewear services are covered.
Dental Services See details
Dental services are covered under the Anthem Grocery (PPO) plan, 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. There is a $1,000 maximum plan benefit coverage 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 Grocery (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs; other services have coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Anthem Grocery (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem Grocery (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $140, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $415, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Grocery (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Grocery (PPO), but the specific services are not covered. Prior authorization is required, and copay information is available, though not explicitly stated in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Grocery (PPO) plan, requiring prior authorization. For days 1-20, there is no copay, while days 21-100 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with no copay and a maximum benefit of $60 every three months, but acupuncture, meal benefits, and many other services are not covered. This plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit.
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