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Anthem Medicare Advantage (Regional PPO)

Anthem Blue Cross and Blue Shield
Anthem Medicare Advantage (Regional PPO) R4487-001 Plan Details
4 out of 5 stars

Anthem Medicare Advantage (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: R4487-001

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$73.00
Monthly Premium

Anthem Medicare Advantage (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: R4487-001

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Anthem Blue Cross and Blue Shield
Anthem Medicare Advantage (Regional PPO) R4487-001 Plan Details
4 out of 5 stars

Anthem Medicare Advantage (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: R4487-001

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$73.00
Monthly Premium

Indiana Counties Served

Hancock Vigo Marion Tippecanoe Madison Tipton Fulton Perry Jay Brown Daviess Porter Steuben Monroe Lawrence Miami Hendricks Blackford Decatur Union Newton Grant Henry Posey Parke Clay Spencer Ohio Jennings Johnson Wabash Cass Sullivan Greene Orange Clinton Boone Montgomery Scott Crawford Shelby Rush Jackson Harrison Jefferson Hamilton Switzerland Marshall Putnam Ripley Kosciusko Pulaski Washington Vermillion Lagrange Wayne Starke Fountain Gibson Carroll Delaware Dubois Allen Lake Martin Howard Dearborn Vanderburgh Elkhart Wells Dekalb Jasper La Porte Knox Whitley Franklin Warren Owen Pike White Randolph Bartholomew Warrick Morgan Fayette Floyd St Joseph Noble Clark Adams Benton Huntington

Kentucky Counties Served

Ballard Kenton Morgan Martin Robertson Hardin Madison Scott Jackson Crittenden Garrard Christian Laurel Pulaski Webster Oldham Jefferson Knott Lyon Nelson Henderson Monroe Trimble Washington Perry Pike Owsley Simpson Claiborne Montgomery Whitley Caldwell Union Letcher Johnson Metcalfe Livingston Lewis Lawrence Hopkins Grayson Estill Mclean Floyd Logan Mercer Magoffin Franklin Boone Bourbon Clay Nicholas Clark Henry Pendleton Russell Fulton Jessamine Bell Marshall Knox Boyd Grant Harlan Carroll Bullitt Hancock Rowan Adair Todd Graves Taylor Mccracken Anderson Trigg Wayne Greenup Fleming Casey Bracken Mason Barren Rockcastle Mccreary Pickett Warren Spencer Hart Meade Green Carlisle Allen Wolfe Marion Gallatin Harrison Leslie Daviess Breckinridge Muhlenberg Edmonson Cumberland Lee Woodford Clinton Elliott Fayette Menifee Hickman Calloway Campbell Boyle Butler Shelby Bath Owen Larue Powell Ohio Carter

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $6400
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:
$0.00 copay
Out-of-Network:
$40.00 copay
Specialty Doctor Visit
In-Network:
$40.00 copay
Out-of-Network:
$60.00 copay
Inpatient Hospital Care
In-Network:
Days 1-7: $290.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Out-of-Network:
30% coinsurance per stay
Urgent Care
Urgent Care: $35.00 copay
Emergency Room Visit
Emergency Care: $90.00 copay
Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year.
Ambulance Transportation
Ground Ambulance: $295.00 copay Per Trip
Air Ambulance: $295.00 copay

Health Care Services and Medical Supplies

Anthem Medicare Advantage (Regional PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Medicare Covered Chiropractic Services: $15.00 copay
Out-of-Network:
Medicare Covered Chiropractic Services: $60.00 copay
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Diabetic Supplies: $0.00 copay
Out-of-Network:
40% coinsurance
Durable Medical Eqipment (DME)
In-Network:
20% coinsurance
Out-of-Network:
40% coinsurance
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Lab Services: $0.00 copay - $10.00 copay
X-Rays: $50.00 copay - $110.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - $145.00 copay
Diagnostic Radiological Services: $105.00 copay - $175.00 copay
Out-of-Network:
Lab Services: 35% coinsurance
X-Rays: 35% coinsurance
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: 35% coinsurance
Diagnostic Radiological Services: 35% coinsurance
Home Health Care
In-Network:
$0.00 copay
Out-of-Network:
40% coinsurance
Mental Health Inpatient Care
In-Network:
Days 1-5: $260.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Out-of-Network:
30% coinsurance per stay
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: $40.00 copay
Out-of-Network:
$60.00 copay
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: 20% coinsurance
Observation Services: 20% coinsurance
Ambulatory Surgical Center: $265.00 copay
Out-of-Network:
Outpatient Hospital - Surgery: 40% coinsurance
Observation Services: 40% coinsurance
Ambulatory Surgical Center: 40% coinsurance
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $40.00 copay
Out-of-Network:
40% coinsurance
Over-the-counter (OTC) Items
This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $35 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - $40.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Out-of-Network:
Medicare Covered Podiatry Services: $60.00 copay
Routine Foot Care: $60.00 copay
Skilled Nursing Facility Care
In-Network:
SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $203.00 per day
Out-of-Network:
50% coinsurance per stay

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:
Preventive Dental Services: $0.00 copay
This plan covers 1 oral exam(s), 1 cleaning(s) every year.

Medicare Covered Dental: $0.00 copay
Out-of-Network:
Medicare Covered Dental Services: $0.00 copay
Preventive Dental: 20% coinsurance

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:
Medicare Covered Eye Exam: $0.00 copay - $40.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year. $69.00 maximum eye exam coverage amount.
Medicare Covered Eye Wear: $0.00 copay
Out-of-Network:
Medicare Covered Eye Exam: $60.00 copay
Routine Eye Exam: $0.00 copay
Medicare Covered Eye Wear: $0.00 copay

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:
Medicare Covered Hearing Exam: $40.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam up to a $59.00 maximum plan benefit every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $2,000.00 maximum plan benefit for prescribed hearing aids every year.
Out-of-Network:
Medicare Covered Hearing Exam: $60.00 copay
Routine Hearing Exam: 20% coinsurance for routine hearing exam(s).

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services
Out-of-Network:
40% coinsurance
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