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Anthem Medicare Advantage (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (Regional 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 (Regional PPO) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (Regional PPO) is a Regional PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Indiana and Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (Regional 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 (Regional 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 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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 $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
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 (Regional PPO) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 copay at preferred pharmacies and a $0 copay via standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage (Regional PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for many services, such as preventive care, routine hearing exams, and oral exams and cleaning. The plan also covers ambulance services, emergency care, and primary care services, with copays ranging from $0 to $345. Additional benefits include coverage for hearing aids (up to $2000/year), vision services, and home health services with no copays. The plan also provides coverage for home infusion, dialysis, and medical equipment. However, certain services like cardiac rehabilitation, orthodontics, and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Anthem Medicare Advantage (Regional PPO) plan. For Inpatient Hospital-Acute, you pay a copay of $345 for days 1-7, and no copay for days 8-90; additional days are covered with no copay. Inpatient Hospital Psychiatric also has a copay of $345 for days 1-6, and no copay for days 7-90; additional days are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay ranging from $0 to $345 for outpatient hospital services and a $345 copay for observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage (Regional PPO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $295 copay for both ground and air ambulance services and no coinsurance. 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 this plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay with no coinsurance, while Urgently Needed Services have a $35 copay with no coinsurance. Worldwide Emergency Services also has a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Medicare Advantage (Regional PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services, podiatry services, and other health care professional services, as well as psychiatric services and physical therapy/speech-language pathology services, all with varying copays. Additional telehealth benefits have no copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered with no copay. Additional preventive services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 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 $2000 per year, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and routine eye exams with no copay. Eyewear is covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams and prophylaxis (cleaning) with no copay, but are limited to one visit per year; dental x-rays and fluoride treatments are optional, supplemental benefits and may require additional costs. Orthodontic, restorative, and other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Medicare Advantage (Regional PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%.
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. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $145, Lab Services have no copay, Diagnostic Radiological Services have a copay between $50 and $345, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage (Regional PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Medicare Advantage (Regional PPO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (Regional PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Medicare Advantage (Regional PPO) plan covers over-the-counter (OTC) items with no copay and a maximum benefit coverage amount of $35 every three months. Other services like acupuncture, meal benefits, and additional services are not covered.
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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.
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