A non-government entity
Anthem I MaineHealth Advantage Veteran (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Veteran (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem I MaineHealth Advantage Veteran (PPO) in 2026, please refer to our full plan details page.
Anthem I MaineHealth Advantage Veteran (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in ME. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Anthem I MaineHealth Advantage 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 I MaineHealth Advantage 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 I MaineHealth Advantage 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 $64.00. 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 $11500.00 (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 $11500.00 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 I MaineHealth Advantage Veteran (PPO)
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Drug Coverage
Prescription drugs are not covered by Anthem I MaineHealth Advantage Veteran (PPO).
Additional Benefits
The Anthem I MaineHealth Advantage Veteran (PPO) offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $350 daily copay for the first five days, with no copay for subsequent days. Emergency room visits require a $115 copay, while specialist visits and urgent care carry a $45 and $40 copay, all with no coinsurance. Supplemental coverage includes a $750 annual dental benefit with no copay for preventive services, plus a routine eye exam and a $200 eyewear allowance with no copay. Routine hearing exams and over-the-counter hearing aids feature no copay, alongside a $1,000 annual allowance for prescription hearing aids. Members also receive up to 24 one-way transportation trips per year and a $35 quarterly over-the-counter item allowance, both with no copay and no coinsurance.
Inpatient Hospital See details
Anthem I MaineHealth Advantage Veteran (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and certain services like upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $350, observation services require a $350 copay per stay, and outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Anthem I MaineHealth Advantage Veteran (PPO) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers ambulance services with a $323 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem I MaineHealth Advantage Veteran (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and opioid treatment services require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $35 copay and no coinsurance, podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive services are partially covered, offering memory fitness and remote access technologies with no copay and no coinsurance, while sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers hearing services with no coinsurance, requiring a $45 copay for Medicare-covered exams and no copay for routine exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with no copay up to a $1,000 annual limit, though inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the Anthem I MaineHealth Advantage Veteran (PPO) with no deductibles, no coinsurance, and copays ranging from $0 to $45. The plan includes one routine eye exam per year and a $200 annual eyewear allowance with no copay, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem I MaineHealth Advantage Veteran (PPO) offers partially covered dental services with a combined annual maximum benefit of $750. Diagnostic and preventive care features no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem I MaineHealth Advantage Veteran (PPO), with durable medical equipment requiring no copay and 0% to 20% coinsurance, and prosthetics and medical supplies requiring no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem I MaineHealth Advantage Veteran (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $140 copay for procedures, while radiological services require a $50 copay plus coinsurance for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance alongside copays for therapeutic radiology.
Home Health Services See details
Anthem I MaineHealth Advantage Veteran (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Anthem I MaineHealth Advantage Veteran (PPO) with no copay and no coinsurance, meaning some services are covered, though prior authorization is required. However, 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
Anthem I MaineHealth Advantage Veteran (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem I MaineHealth Advantage Veteran (PPO) partially covers Other Services, providing Over-the-Counter (OTC) items with no copay and no coinsurance up to a limit of $35 every three months. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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