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 2026, 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 2026.
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 $87.00. 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 $250.00 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 features an annual drug deductible of $250. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs across preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic medications also feature no copay at preferred pharmacies and standard mail order, with standard pharmacy copays starting at just $5 for a one-month supply. For higher-tier medications, costs are based on a coinsurance percentage rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% coinsurance. These coinsurance rates apply consistently across preferred pharmacies, standard pharmacies, and standard mail order options.
Additional Benefits
The Anthem Medicare Advantage (Regional PPO) plan offers dependable medical coverage with no coinsurance for most standard services, including inpatient hospital stays that require a $295 daily copay for days 1 through 7 and no copay for longer stays. Patients pay a low $10 copay for primary care visits, while specialist visits and urgent care require copays of $40 and $35, respectively. Emergency services are covered with a $130 copay, and both preventive care and telehealth sessions are provided with no copay. For additional care, the plan features routine dental, vision, and hearing exams with no copay, as well as up to $2,000 for prescription hearing aids, though eyewear and advanced dental treatments are not covered. Home health services and diabetic supplies are also covered with no copay, while durable medical equipment and dialysis require up to 20% coinsurance. Additionally, skilled nursing facility stays are available with no copay for the first 20 days.
Inpatient Hospital See details
Anthem Medicare Advantage (Regional PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 7 and no copay for days 8 and beyond. Inpatient hospital care is partially covered under this plan, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (Regional PPO) covers outpatient services with no coinsurance, featuring a $0 to $295 copay for outpatient hospital care and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage (Regional PPO) with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (Regional PPO) partially covers ambulance and transportation services, offering Medicare-covered ground and air ambulance services for a $330 copay and no coinsurance. Routine transportation services to plan-approved or any health-related locations are not covered, and prior authorization is required for ambulance services.
Emergency Services See details
Anthem Medicare Advantage (Regional PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
Primary care services under the Anthem Medicare Advantage (Regional PPO) plan are covered with a $10 copay and no coinsurance, while specialist, therapy, and mental health visits require a $40 copay and no coinsurance. Additional telehealth benefits are offered with no copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (Regional PPO) offers preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and remote access technologies. This benefit is partially covered, as sub-services such as fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Anthem Medicare Advantage (Regional PPO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Anthem Medicare Advantage (Regional PPO), which offers one routine eye exam per year with no copay and no coinsurance up to a $69 maximum, while other eye exams require a copay of up to $40 with no coinsurance. Eyewear is not covered by the plan, as contact lenses, eyeglasses, lenses, frames, and upgrades are all excluded.
Dental Services See details
Anthem Medicare Advantage (Regional PPO) offers partially covered dental services with no copay and no coinsurance for covered benefits like annual oral exams, cleanings, dental x-rays, and fluoride treatments. However, other diagnostic and preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem Medicare Advantage (Regional PPO) with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (Regional PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (Regional PPO) covers durable medical equipment (DME) and prosthetics with no copay and 0% to 20% coinsurance, subject to prior authorization and preferred vendor requirements. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though brand restrictions apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (Regional PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $130 copay for diagnostic tests. Radiological services are also covered with prior authorization, featuring a minimum $50 copay for diagnostic radiology, a $90 copay plus coinsurance for X-rays, and a minimum 20% coinsurance plus a copay for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage (Regional PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Anthem Medicare Advantage (Regional PPO) plan with no coinsurance, though prior authorization is required. While some services are covered, Cardiac Rehabilitation ($35 copay), Intensive Cardiac Rehabilitation ($35 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for Peripheral Artery Disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (Regional PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-defined limit are not covered.
Other Services See details
Other Services are not covered under the Anthem Medicare Advantage (Regional PPO) plan, which excludes coverage for acupuncture, over-the-counter (OTC) items, and meal benefits. Because these services are not covered by the plan, there are no associated copayments or coinsurance options available.
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