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Anthem Medicare Advantage (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$0.00
Monthly Premium
Anthem Medicare Advantage (PPO) is a PPO plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4909-016
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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Anthem Medicare Advantage (PPO) - H4909-016 by Anthem Blue Cross and Blue Shield as well as other Medicare Advantage plans available in your area.
$0.00
Monthly Premium
Missouri Counties Served
AdairAudrainBarryBartonBollingerBooneButlerCallawayCamdenCape GirardeauCarterCedarCharitonChristianClarkColeCooperCrawfordDadeDallasDentDouglasDunklinFranklinGasconadeGreeneHickoryHowardHowellIronJasperJeffersonKnoxLacledeLawrenceLewisLincolnLinnMaconMadisonMariesMarionMcDonaldMillerMississippiMoniteauMonroeMontgomeryMorganNew MadridNewtonOregonOsageOzarkPemiscotPerryPhelpsPikePolkPulaskiPutnamRallsRandolphReynoldsRipleySaint CharlesSaint FrancoisSaint LouisSaint Louis CitySainte GenevieveSchuylerScotlandScottShannonShelbyStoddardStoneSullivanTaneyTexasWarrenWashingtonWayneWebsterWright
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $3900 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $8000 |
| Primary Care Doctor Visit | In-Network: $0.00 copay |
| Specialty Doctor Visit | In-Network: $40.00 copay |
| Inpatient Hospital Care | Out-of-Network: 50% 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: $275.00 copay Per Trip Air Ambulance: $275.00 copay |
Health Care Services and Medical Supplies
Anthem Medicare Advantage (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: $20.00 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 |
| Durable Medical Equipment (DME) | Out-of-Network: 40% coinsurance |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay - $20.00 copay X-Rays: $50.00 copay - $115.00 copay Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - $95.00 copay Diagnostic Radiological Services: $95.00 copay - $195.00 copay |
| Home Health Care | In-Network: $0.00 copay |
| Mental Health Inpatient Care | Out-of-Network: 50% coinsurance per stay |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $40.00 copay |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $285.00 copay Observation Services: $285.00 copay Ambulatory Surgical Center: $245.00 copay |
| 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 $67 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 | Out-of-Network: Medicare Covered Podiatry Services: $60.00 copay Routine Foot Care: $60.00 copayIn-Network: Medicare Covered Podiatry Services: $0.00 copay - $40.00 copay Routine Foot Care: $0.00 copay Unlimited routine foot care visits each year. |
| Skilled Nursing Facility Care | In-Network: SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $203.00 per day |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | Out-of-Network: Medicare Covered Dental Services: Copayment for Medicare Covered Comprehensive Dental $0.00 Non-Medicare Covered Dental Services: Coinsurance for Non-Medicare Covered Preventive Dental 20% Copayment for Non-Medicare Covered Comprehensive Dental $0.00 |
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 Routine Eye Wear: $0.00 copay This plan covers up to $150.00 for eyeglasses or contact lenses every year. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | 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 |