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Anthem Medicare Advantage (Regional PPO)

Anthem Blue Cross and Blue Shield
Anthem Medicare Advantage (Regional PPO) R4487-001 Plan Details
3.5 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 2025 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.

$74.00
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 2025 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
3.5 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 2025 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.

$74.00
Monthly Premium

Indiana Counties Served

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

Kentucky Counties Served

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

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $6750
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
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: $345.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Out-of-Network:
30% coinsurance per stay
Urgent Care
Urgent Care: $35.00 copay
Emergency Room Visit
Emergency Care: $125.00 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 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: $50.00 copay - $345.00 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 1-6: $345.00 per day, per admission / Days 7-90: $0.00 per day, per admission
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: $345.00 copay
Observation Services: $345.00 copay
Ambulatory Surgical Center: $295.00 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 expire at the end of the 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:
Days 1 - 20: $0.00 per day / Days 21 - 100: $214.00 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
This plan covers 1 oral exam(s), and 1 cleaning(s) every year.

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

Out-of-Network:
Medicare Covered Dental: $0.00 copay
Non-Medicare Preventive Dental Services: 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 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 maximum plan benefit every year. $300 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $2,000 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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