A non-government entity
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 Ohio. 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 $81.00. 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 $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $50.00 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 $10100.00 (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 $10100.00 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 a $50 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies and a $0 copay at standard mail order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Medicare Advantage (Regional PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with various copays, and emergency services with copays. Primary care, preventive, hearing, vision, and dental services are included, with some services like routine exams and cleanings having no copay. The plan also covers home health services with no copay, and medical equipment and supplies with either no copay or coinsurance. Additional benefits include coverage for ambulance, and skilled nursing facility services. However, certain services like cardiac rehabilitation, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 7 days of an inpatient hospital stay, there is a $295 copay per day, and days 8-90 have no copay; additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute 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 $295, observation services with a $295 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage (Regional 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 the Anthem Medicare Advantage (Regional PPO) plan. Ground and Air Ambulance Services have a $290 copay, but there is 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 the Anthem Medicare Advantage (Regional PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Medicare Advantage (Regional PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, podiatry services with a copay between $0 and $40, other health care professional services with a copay between $10 and $20, psychiatric services with a $40 copay, physical and speech therapy services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay. Routine Chiropractic care is not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, including fitness benefits and remote access technologies, are covered with no copay.
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 for both ears combined, and all types of prescription hearing aids have no copay.
Vision Services See details
Vision services include eye exams with a copay between $0 and $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
The Anthem Medicare Advantage (Regional PPO) plan covers oral exams and prophylaxis (cleaning) with no copay, but is limited to one visit per year for each. Dental X-Rays and Fluoride Treatment are offered as optional, supplemental benefits. Orthodontic Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Medicare Advantage (Regional PPO) plan, including 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%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (Regional PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic and radiological services, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $130, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $295, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (Regional PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
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, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered under the Anthem Medicare Advantage (Regional PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, 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.
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