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Anthem Veteran (PPO) - H4036-040-000

4 out of 5 stars* for plan year 2025

$0.00

Monthly Premium

Anthem Veteran (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield

Plan ID: H4036-040-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0.00

Monthly Premium

Georgia Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Georgia Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

CoverageDetails
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible-$1.00
Out-of-pocket maximum$9,350.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$2,000.00
Primary care doctor visitIn-Network:
$20.00 copay
Specialty doctor visit
Out-of-Network:
50% coinsurance
Inpatient hospital care
Out-of-Network:
50% coinsurance per stay
Urgent careUrgent Care: $45.00 copay
Emergency room visitEmergency Care: $110.00 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 per year.
Ambulance transportationGround Ambulance: $285.00 copay Per Trip
Air Ambulance: $285.00 copay

Health Care Services and Medical Supplies

Anthem Veteran (PPO) covers a range of additional benefits. Learn more about Anthem Veteran (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

CoverageDetails
Chiropractic services
Out-of-Network:
Medicare Covered Chiropractic Services: 50% coinsurance
Diabetes supplies, training, nutrition therapy and monitoring
Out-of-Network:
50% coinsurance
Durable medical equipment (DME)
Out-of-Network:
50% coinsurance
Diagnostic tests, lab and radiology services, and X-rays
Out-of-Network:
Lab Services: 50% coinsurance
X-Rays: 50% coinsurance
Therapeutic Radiological Services: 50% coinsurance
Outpatient Diagnostic Procedures/Tests: 50% coinsurance
Diagnostic Radiological Services: 50% coinsurance
Home health care
Out-of-Network:
50% coinsurance
Mental health inpatient care
Out-of-Network:
50% coinsurance per stay
Mental health outpatient careIn-Network:
Individual and Group Sessions: $45.00 copay
Outpatient services/surgeryIn-Network:
Outpatient Hospital - Surgery: $375.00 copay
Observation Services: $375.00 copay
Ambulatory Surgical Center: $325.00 copay
Outpatient substance abuse careIn-Network:
Individual and Group Sessions: $50.00 copay
Podiatry services
Out-of-Network:
Medicare Covered Podiatry Services: 50% coinsurance
Routine Foot Care: 50% coinsurance
Skilled Nursing Facility (SNF) careIn-Network:
Days 1 - 20: $0.00 per day / Days 21 - 100: $214.00 per day

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Dental careThis plan covers up to a $2,250 allowance for covered preventive and comprehensive dental services every year.

In-Network:
Medicare Covered Dental: $0.00 copay
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage

CoverageDetails
Vision careIn-Network:
Medicare Covered Eye Exam: $0.00 copay - $50.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year. $69 maximum eye exam coverage amount.
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
This plan covers up to $200 for eyeglasses or contact lenses every year.

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Hearing careIn-Network:
Medicare Covered Hearing Exam: $50.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s).
This plan covers 1 routine hearing exam up to a $59 maximum plan benefit every year.

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Preventive services and health/wellness education programs
Out-of-Network:
50% coinsurance

When reviewing Georgia Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Georgia that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Georgia Counties Served

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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