Anthem PPO

Medicare Advantage PPO including Rx Coverage

This Anthem PPO plan allows you to use any doctor, hospital, or medical provider that accepts Medicare. Over 93% of all doctors accept Medicare. This plan is good in all 50 states and the District of Columbia. Some coverage is available worldwide while traveling.

Unlike HMO-style plans, you may go to any doctor, specialist, or hospital without a referral. The provider does not need to be part of the Anthem network. The only requirement is that they accept Medicare.

Physician Services

Primary Care Physician and Specialists


Annual Physical Exams

Wellness Exam (Medicare Exam) and Routine Physical Exam


Inpatient Services

Inpatient Stay including Hospital and Mental Health

Skilled Nursing Facility Care

Blood including Storage and Administration


Outpatient Services

Office Visits and Telehealth office visits

Specialist Consultation, Diagnosis, and Treatment

Retail health clinics

Basic diagnostic hearing and balance exams

Second opinion prior to surgery

Physician services rendered in the home

Outpatient services including hospital, mental health care, and substance abuse


Prescription Drugs

30 Day Supply for Retail
90 Day Supply for Mail Order

Preferred Network Pharmacy*

Standard Network Pharmacy

Mail Order Pharmacy

Select Generic


Preferred Brand

Non-Preferred Brand & Non-Formulary

















Catastrophic Coverage

Select Generic


Brand Name



Greater of $3.70 copay or 5%

Greater of $9.20 copay or 5%

Part D Gap “Donut Hole” Coverage


Part B Drugs - Immunosuppresses, anti-nausea, inhalation solutions, outpatient injectables, and chemotherapy drugs


Extra Covered Drugs

Preferred Network Pharmacy*

Standard Network Pharmacy

Cough and Cold

Drug Efficacy Study Implementation (DESI)

Vitamins and Minerals

Lifestyle Drugs, including Erectile Dysfunction (ED)

See Formulary for complete list

of drugs covered

Generics / Preferred Brands / Non-Preferred Brands

You pay your Preferred

Retail or Mail-Order copay

Note: Extra Covered Drugs are covered drugs that are often excluded from Part D coverage. Some of these drugs may be required on your drug plan by state regulations. These drugs do not count towards your True Out of Pocket expenses. They do not qualify for lower Catastrophic copays. If you have a deductible, it does not apply to these drugs. These drugs are covered by your Senior Rx Plus benefits.
*This plan uses the IngenioRx network of preferred pharmacies. There are over 70,000 pharmacies in the network and include Walmart, Kroger, CVS Pharmacy, more than 5,000 Health Mart Atlas pharmacies, and many independent pharmacies.

Preventative Services (Medicare Covered)

Bone Mass Measurements

Colorectal Screening Exams


Pap Smears and Pelvic Exams

Prostate Cancer Screening Exams

Cardiovascular Screenings

Smoking Cessation Visit

Abdominal Aortic Aneurysm (AAA) Screening

Diabetes Screening

HIV Screening

Screening and Behavioral Counseling to Reduce Alcohol Misuse

Depression Screening

Screening for Sexually Transmitted Infections

Screening and Counseling for Obesity

Diabetes - Self-Management Training

Medical Nutrition Therapy and Counseling

Glaucoma Screening

Kidney Disease Education



Flu, Pneumonia, Hepatitis B, & Other Vaccines if at risk and meet Medicare rules


Podiatry Services

Treatment of injuries and disease of the feet

Foot care with conditions affecting lower limbs

Exam for people with diabetic peripheral


Emergency / Urgently Care / Ambulance Services

Ambulance Services


Emergency Room


Urgently Needed Care (Medicare Covered)


Home Healthcare Agency

Home Care Visits

Hospice (Medicare Covered)


Durable Medical Equipment

Durable Medical Equipment, Diabetes Monitoring Supplies, and Medical Supplies



Other Wellness Services

Vision Care for Injury or Diagnosis of Disease

Silver Sneakers Gym Access

Nurse HelpLine

Routing Foot Care

Video Doctor Visits

Healthy Food Deliveries



Chiropractic Services




Hearing Aid Allowance



Foreign Travel

Emergency Outpatient Care


Urgently Needed Services


Emergency Inpatient Care


Emergency or urgently needed care services while traveling outside the United States or its territories during a temporary absence of less than six months. Outpatient copay is waived if member is admitted to hospital within 72 hours for the same condition.

This coverage is worldwide and is limited to what is allowed under the Medicare fee schedule for the services performed/received in the United States.

The above is a summary of plan benefits and not a comprehensive list. While believed accurate, nothing listed above can change or alter the Certificate of Insurance.