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 2026 to people living in Indiana and Kentucky. 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 $97.00. 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 a $45.00 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 $13900.00 (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 $13900.00 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 a low annual drug deductible of $45. You will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs when using a preferred pharmacy or standard mail order. Tier 2 generic drugs are also highly affordable, starting at an $8 copay for a one-month supply at preferred pharmacies and featuring no copay through standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require 25% coinsurance, Tier 4 non-preferred drugs require 30% coinsurance, and Tier 5 specialty drugs require 32% coinsurance for a one-month supply. These coinsurance rates apply consistently across preferred pharmacies, standard pharmacies, and standard mail order.
Additional Benefits
The Anthem Medicare Advantage (Regional PPO) plan offers comprehensive medical coverage with no copays or coinsurance for primary care, telehealth, and annual preventive services. Specialist visits and outpatient therapies are highly accessible, featuring low copays from $0 to $40 and no coinsurance. For urgent needs and emergencies, members pay a $35 and $115 copay respectively, while inpatient hospital stays require a $345 daily copay for the first week before transitioning to no copay. This plan also includes valuable supplemental benefits, featuring no copays or coinsurance for routine hearing exams, annual dental cleanings, and a yearly routine eye exam. Prescription hearing aids are covered up to a $2,000 annual limit with no copay, and members receive a $35 allowance every three months for over-the-counter health products. Additionally, home health services and the first 20 days of skilled nursing facility care are covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Medicare Advantage (Regional PPO) with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute stays require a $345 daily copay for days 1 through 7 followed by no copay, while psychiatric stays require a $345 daily copay for days 1 through 6 followed by no copay.
Outpatient Services See details
Anthem Medicare Advantage (Regional PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $345 for outpatient hospital services and a $345 copay per stay for observation services, both requiring prior authorization. Ambulatory surgical center and outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse individual and group sessions require prior authorization and a $40 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem Medicare Advantage (Regional PPO) with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (Regional PPO) partially covers ambulance and transportation services, with ground and air ambulance services requiring a $350 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (Regional PPO) covers emergency services with a $115 copay and no coinsurance, while urgently needed services require a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit, with a $115 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (Regional PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require no coinsurance and copays ranging from $0 to $40. Some chiropractic services are covered, but routine and other chiropractic services are not covered, and prior authorization is required for most specialist and therapy benefits.
Preventive Services See details
Anthem Medicare Advantage (Regional PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and remote access technologies. This benefit is partially covered, as additional services like health education, fitness benefits, and in-home safety assessments are not covered.
Hearing Services See details
Anthem Medicare Advantage (Regional PPO) covers hearing services with a $40 copay and no coinsurance for Medicare-covered exams, while routine exams and OTC hearing aids require no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, though inner, outer, and over-the-ear models are not covered, and prior authorization is required.
Vision Services See details
Anthem Medicare Advantage (Regional PPO) provides partially covered vision services, which includes one routine eye exam every year with no copay and no coinsurance up to a $69 maximum. Other eye exams and eyewear services, such as contact lenses and eyeglasses, are not covered.
Dental Services See details
Anthem Medicare Advantage (Regional PPO) partially covers dental services with no copay and no coinsurance for Medicare-covered dental care, annual oral exams, annual cleanings, dental x-rays, and fluoride treatments. Restorative, endodontic, periodontic, prosthodontic, oral surgery, orthodontic, implant, adjunctive general, maxillofacial prosthetic, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Medicare Advantage (Regional PPO) 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 a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Anthem Medicare Advantage (Regional PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (Regional PPO) covers medical equipment with no copay, offering durable medical equipment (DME) with 0% to 20% coinsurance and diabetic equipment and supplies with no coinsurance. Prosthetics and medical supplies are also covered with no copay and a 20% coinsurance, with prior authorization or vendor limits applying to some items.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (Regional PPO) covers diagnostic and radiological services with prior authorization, featuring no copay and no coinsurance for lab services, and a $0 to $145 copay with no coinsurance for other diagnostic tests. Diagnostic radiological services require a copay starting at $50, outpatient X-rays carry a $90 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Anthem Medicare Advantage (Regional 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 covered by Anthem Medicare Advantage (Regional PPO) with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Covered options require prior authorization and feature no copay.
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 inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Anthem Medicare Advantage (Regional PPO), which excludes acupuncture and meal benefits but covers over-the-counter (OTC) items. Covered OTC items have no copay and no coinsurance, providing a maximum benefit of $35 every three months.
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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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