Anthem Medicare Advantage (Regional PPO)

^$87.00

Monthly Premium

Anthem Medicare Advantage (Regional PPO) is a Regional PPO plan offered by Anthem Inc.

Plan ID: R5941-014

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 (Regional PPO) - R5941-014 by Anthem Inc. as well as other Medicare Advantage plans available in your area.

^$87.00

Monthly Premium

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$250
Out of Pocket Max	In-Network: $6750 Out-of-Network: 10100
Initial Coverage Limit	$0
Catastrophic Coverage Limit	$2100
Primary Care Doctor Visit	Out-of-Network: $50% coinsurance
Specialty Doctor Visit	Out-of-Network: $50% coinsurance
Inpatient Hospital Care	In-Network: Days 1-7: $295.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Urgent Care	Urgent Care: $35.00 copay
Emergency Room Visit	Emergency Care: $130.00 copay Worldwide Coverage: This plan covers urgent care and emergency services, including emergency transportation, 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: $330.00 copay Per Trip Air Ambulance: $330.00 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	Out-of-Network: Medicare Covered Chiropractic Services: 50% coinsuranceIn-Network: Medicare Covered Chiropractic Services: $15.00 copay
Diabetes Supplies, Training, Nutrition Therapy and Monitoring	In-Network: Diabetic Supplies: $0.00 copay
Durable Medical Equipment (DME)	Out-of-Network: 50% coinsurance
Diagnostic Tests, Lab and Radiology Services, and X-Rays	In-Network: Lab Services: $0.00 copay - $10.00 copay X-Rays: $90.00 copay - $110.00 copay Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - $130.00 copay Diagnostic Radiological Services: $50.00 copay - $295.00 copay
Home Health Care	Out-of-Network: 50% coinsurance
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: $295.00 copay Observation Services: $295.00 copay Ambulatory Surgical Center: $170.00 copay
Outpatient Substance Abuse Care	Out-of-Network: 50% coinsuranceIn-Network: Individual and Group Sessions: $40.00 copay
Over-the-counter (OTC) Items
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: 50% coinsurance Routine Foot Care: 50% coinsurance
Skilled Nursing Facility Care	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 and 1 cleaning every year. In-Network Medicare Covered Dental: $0.00 copay Preventive Dental: $0.00 copay

Vision Benefits

The following vision services are covered from in-network providers.

Coverage	Cost
Vision Benefits	Out-of-Network: Medicare Covered Eye Exam: 50% coinsurance 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	Out-of-Network: Medicare Covered Hearing Exam: 50% coinsurance 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

Prescription Drug Costs and Coverage

The Anthem Medicare Advantage (Regional PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $250 (excludes Tiers 1, 2 and 6) per year.

Coverage	Cost
Coverage & Cost
Annual Drug Deductible	$250 (excludes Tiers 1, 2 and 6)
Preferred Generic	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Generic	Standard retail $5.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Select Care Drugs	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Annual Drug Deductible	$250 (excludes Tiers 1, 2 and 6)
Preferred Generic	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Generic	Standard retail $10.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Select Care Drugs	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Annual Drug Deductible	$250 (excludes Tiers 1, 2 and 6)
Preferred Generic	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Generic	Standard retail $15.00 Standard mail order $0.00 Preferred cost-share retail $0.00
Select Care Drugs	Standard retail $0.00 Standard mail order $0.00 Preferred cost-share retail $0.00

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