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 2025, 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 2025.
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 $100.00. 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 $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:
Sign up for Anthem I MaineHealth Advantage Veteran (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Anthem I MaineHealth Advantage Veteran (PPO).
Additional Benefits
The Anthem I MaineHealth Advantage Veteran (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay of $290 per day for the first five days, and then no copay for the remainder of the stay. Outpatient services have a range of copays, and primary care visits have no copay, while specialist visits have a $45 copay. Preventive services, including annual physical exams, are covered with no copay, and the plan includes additional benefits like hearing, vision, and dental services. Hearing services have a $45 copay for hearing exams and no copay for routine exams and hearing aids up to a $1,000 annual maximum. Vision services include eye exams with no copay and eyewear benefits with a maximum of $200 every year. Dental services include oral exams, dental x-rays, and other diagnostic services with no copay, with a maximum plan benefit of $2500 per year.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, the copay is $290 per day for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, the copay is also $290 per day for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $290, observation services with a $290 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem I MaineHealth Advantage Veteran (PPO) plan. Ground and Air Ambulance Services have a $290 copay, with no coinsurance, and Transportation Services to a plan-approved health-related location have no copay, with no coinsurance, for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay for routine care, but routine chiropractic care is not covered. Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $45 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a copay of $40. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, with no copay. Annual physical exams are covered with no copay, and additional preventive services are covered. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $45 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $1,000 per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with no copay. Routine eye exams have no copay, and eyewear benefits have a combined maximum of $200 every year.
Dental Services See details
Dental Services are covered by the Anthem I MaineHealth Advantage Veteran (PPO) plan, including oral exams, dental x-rays, and other diagnostic services with no copay, with a maximum plan benefit of $2500 per year. The plan also covers orthodontics, restorative services, and other services with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem I MaineHealth Advantage Veteran (PPO) plan. This includes Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem I MaineHealth Advantage Veteran (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $140, and lab services with no copay. Radiological services are also covered, with diagnostic radiological services having a copay between $50 and $290, therapeutic radiological services having 20% coinsurance, and outpatient X-ray services having a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem I MaineHealth Advantage Veteran (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific cardiac rehabilitation services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF 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 $50 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved