A non-government entity
Anthem Medicare Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (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 (PPO) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $95.00 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 $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
The Anthem Medicare Advantage (PPO) plan features a low annual drug deductible of $95. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. For Tier 2 generic drugs, copays start at $9 at preferred pharmacies, while standard mail-order services offer these generics with no copay. For higher-tier medications, costs are shared via coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, rising to 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% coinsurance, while Tier 5 specialty drugs require a 31% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, telehealth visits, preventive services, and home health care. For specialized care, members pay a $30 copay for specialist visits and a $130 copay for emergency room services, both featuring no coinsurance. Inpatient hospital stays require a $345 daily copay for the first five days and no copay for subsequent days, while outpatient hospital services range from no copay up to a $345 copay. Ancillary benefits include preventive dental care, routine hearing exams, and routine vision care with no copay and no coinsurance. The plan also covers prescription hearing aids up to a $1,500 annual limit and comprehensive dental services with no copay and 25% coinsurance up to a $2,750 annual maximum. Additionally, diabetic supplies and therapeutic shoes are available with no copay and no coinsurance, while durable medical equipment features no copay and coinsurance up to 20%.
Inpatient Hospital See details
Anthem Medicare Advantage (PPO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $345 daily copay for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required for these services, and non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services have a $0 to $345 copay, observation services require a $345 copay per stay, and outpatient substance abuse sessions carry a $30 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem Medicare Advantage (PPO) plan with a $40.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (PPO) covers ground and air ambulance services with a $265 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (PPO) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Medicare Advantage (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services carry a $30 copay and no coinsurance. Podiatry and other professional services feature copays up to $30 with no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering remote access technologies with no copay and no coinsurance, while sub-services such as fitness benefits, health education, and weight management programs are not covered.
Hearing Services See details
Anthem Medicare Advantage (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,500 annual limit, but 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 a $300 annual limit.
Vision Services See details
Anthem Medicare Advantage (PPO) offers partially covered vision services with no deductibles and no coinsurance. Routine eye exams and eyewear, including lenses, frames, and contacts, are available with no copay up to annual maximums of $69 and $300 respectively, though other eye exam services and upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (PPO) partially covers dental services up to a $2,750 annual maximum for both in-network and out-of-network care. Preventive care options feature no copay and no coinsurance, while covered comprehensive services require no copay and 25% coinsurance, excluding implants, orthodontics, and maxillofacial prosthetics.
Home Infusion bundled Services See details
Anthem Medicare Advantage (PPO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (PPO) covers medical equipment with no copay for durable medical equipment (DME) and coinsurance ranging from no coinsurance to 20%. Prosthetics and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Anthem Medicare Advantage (PPO) with no coinsurance for diagnostic tests, which feature no copay for lab services and a $0 to $75 copay for diagnostic procedures. Outpatient X-rays require a $25 copay, diagnostic radiology has a minimum $50 copay, and therapeutic radiology services carry a minimum 20% coinsurance.
Home Health Services See details
Anthem Medicare Advantage (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Anthem Medicare Advantage (PPO) partially covers other services, offering Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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