2027 Medicare Advantage plan
Anthem Veteran (PPO): 2027 benefits and costs
Anthem Blue Cross and Blue Shield PPO
CMS plan ID: H7093-001-0 · Plan year: 2027
Anthem Veteran (PPO) is a 2027 Medicare Advantage plan offered by Anthem Blue Cross and Blue Shield. It is listed in Indiana.
2027 plan costs at a glance
- Organization
- Anthem Blue Cross and Blue Shield
- Plan organization
- COMMUNITY INSURANCE COMPANY
- Parent company
- Elevance Health, Inc.
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $99.50 (estimated)$209.50 standard premium less $110.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $9,250.00
- Combined in/out-of-network medical maximum
- $13,900.00
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $110.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 50% coinsurance
| |
| Specialist visit | $45.00 copay
| 50% coinsurance
|
|
| Telehealth | $0.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $25.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 0% to 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 0% to 50% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| 20% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $0.00 to $45.00 copay
| 50% coinsurance
|
|
| Other health professionals | $0.00 to $15.00 copay
| 50% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–5: $445.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–4: $445.00 copay per day Days 5–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $445.00 copay
| 50% coinsurance
| |
| Hospital observation services | $445.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $345.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0.00 copay
| $0.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $100.00 copay
| 50% coinsurance
|
|
| Laboratory services | $0.00 to $50.00 copay
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $50.00 to $445.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 50% coinsurance
|
|
| X-rays | $90.00 to $110.00 copay
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $55.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $55.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $45.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $45.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $45.00 copay
| 50% coinsurance
|
|
| Mental health, individual sessions | $45.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $45.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $45.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $45.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $35.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $20.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $290.00 copay
| $290.00 copay
|
|
| Air ambulance | $290.00 copay
| $290.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0.00 copay
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $0.00 copay
| 50% coinsurance
|
|
| Diabetic monitors | $0.00 copay; 20% coinsurance
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $0.00 copay | $0.00 copay
| |
| Oral examsAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| Other diagnostic dentalAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| FluorideAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| Other preventive dentalAdditional plan benefit | $0.00 copay | 20% coinsurance
| |
| Restorative dental careAdditional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 25% coinsurance | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 25% coinsurance | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $45.00 copay
| 50% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| $0.00 copay
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $45.00 copay
| 50% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 20% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 20% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| 80% coinsurance
|
|
| Over-the-counter hearing aidsAdditional plan benefit | $0.00 copay
| 80% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| $0.00 copay
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
| $5.00 copay
|
|
| Annual physical examAdditional plan benefit | $0.00 copay
| 50% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| 75% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 50% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0.00 copay
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 50% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Allowances and optional benefits
Optional packages that cost extra
Enhanced Dental and Vision Package $47.00 extra per month
Enhanced Dental and Vision Package
The limits below apply only to this optional package.
- Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
- No
- Deductible applies
- No
- Included services
- Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames
Dental and Vision Package $28.00 extra per month
Dental and Vision Package
The limits below apply only to this optional package.
- Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
- No
- Deductible applies
- No
- Included services
- Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames
Preventive Dental Package $22.00 extra per month
Preventive Dental Package
The limits below apply only to this optional package.
- Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
- No
- Deductible applies
- No
- Included services
- Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 92 county listings across 1 state or territory
Indiana
- Adams, Indiana
- Allen, Indiana
- Bartholomew, Indiana
- Benton, Indiana
- Blackford, Indiana
- Boone, Indiana
- Brown, Indiana
- Carroll, Indiana
- Cass, Indiana
- Clark, Indiana
- Clay, Indiana
- Clinton, Indiana
- Crawford, Indiana
- Daviess, Indiana
- Dearborn, Indiana
- Decatur, Indiana
- DeKalb, Indiana
- Delaware, Indiana
- Dubois, Indiana
- Elkhart, Indiana
- Fayette, Indiana
- Floyd, Indiana
- Fountain, Indiana
- Franklin, Indiana
- Fulton, Indiana
- Gibson, Indiana
- Grant, Indiana
- Greene, Indiana
- Hamilton, Indiana
- Hancock, Indiana
- Harrison, Indiana
- Hendricks, Indiana
- Henry, Indiana
- Howard, Indiana
- Huntington, Indiana
- Jackson, Indiana
- Jasper, Indiana
- Jay, Indiana
- Jefferson, Indiana
- Jennings, Indiana
- Johnson, Indiana
- Knox, Indiana
- Kosciusko, Indiana
- La Porte, Indiana
- Lagrange, Indiana
- Lake, Indiana
- Lawrence, Indiana
- Madison, Indiana
- Marion, Indiana
- Marshall, Indiana
- Martin, Indiana
- Miami, Indiana
- Monroe, Indiana
- Montgomery, Indiana
- Morgan, Indiana
- Newton, Indiana
- Noble, Indiana
- Ohio, Indiana
- Orange, Indiana
- Owen, Indiana
- Parke, Indiana
- Perry, Indiana
- Pike, Indiana
- Porter, Indiana
- Posey, Indiana
- Pulaski, Indiana
- Putnam, Indiana
- Randolph, Indiana
- Ripley, Indiana
- Rush, Indiana
- Scott, Indiana
- Shelby, Indiana
- Spencer, Indiana
- St. Joseph, Indiana
- Starke, Indiana
- Steuben, Indiana
- Sullivan, Indiana
- Switzerland, Indiana
- Tippecanoe, Indiana
- Tipton, Indiana
- Union, Indiana
- Vanderburgh, Indiana
- Vermillion, Indiana
- Vigo, Indiana
- Wabash, Indiana
- Warren, Indiana
- Warrick, Indiana
- Washington, Indiana
- Wayne, Indiana
- Wells, Indiana
- White, Indiana
- Whitley, Indiana