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Anthem Grocery (PPO)

Anthem Blue Cross and Blue Shield
Anthem Grocery (PPO) H4036-033 Plan Details
4 out of 5 stars

Anthem Grocery (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-033

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.

$0.00
Monthly Premium

Anthem Grocery (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-033

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 Grocery (PPO) H4036-033 Plan Details
4 out of 5 stars

Anthem Grocery (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-033

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.

$0.00
Monthly Premium

Georgia Counties Served

Lamar Pike Upson Monroe Butts Meriwether Jefferson Wilkes Taliaferro Catoosa Walker Dade Crawford Taylor Chattahoochee Harris Muscogee Jasper Chattooga Bartow Heard Burke Bulloch Jenkins Effingham Richmond Lincoln Columbia Mcduffie Chatham Bryan Washington Evans Screven Stephens Union Hart Jackson Rabun Towns Lumpkin Madison Oglethorpe Clarke Oconee Warren Elbert Greene Hancock Glascock Baldwin Mcintosh Camden Gadsden Talbot Marion Randolph Stewart Webster Morgan Dekalb Pickens Spalding Russell Fayette Coweta Clayton Henry Forsyth Cobb Cherokee Rockdale Fulton Douglas Paulding Haralson Murray Walton Polk Barrow Dawson Floyd Gwinnett Newton Carroll Gilmer Troup Habersham Hall Fannin Banks Franklin White Putnam Early Calhoun Miller Seminole Baker Decatur Clay Terrell Grady Lee Quitman Laurens Tattnall Emanuel Wheeler Toombs Treutlen Johnson Long Liberty Ben Hill Dooly Crisp Sumter Wilkinson Pulaski Wilcox Twiggs Houston Dodge Wayne Peach Colquitt Bibb Macon Charlton Jones Coffee Ware Bacon Irwin Pierce Jeff Davis Brooks Cook Tift Clinch Atkinson Lowndes Berrien Lanier Thomas Mitchell Turner Candler Montgomery Bleckley Telfair Brantley Schley Appling Worth Echols

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $295
Out of Pocket Max In-Network: $9300
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:
$50.00 copay
Specialty Doctor Visit
In-Network:
$30.00 copay
Out-of-Network:
$60.00 copay
Inpatient Hospital Care
In-Network:
Days 1-7: $380.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Out-of-Network:
40% coinsurance per stay
Urgent Care
Urgent Care: $35.00 copay
Emergency Room Visit
Emergency 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 Transportation
Ground Ambulance: $270.00 copay Per Trip
Air Ambulance: $270.00 copay

Health Care Services and Medical Supplies

Anthem Grocery (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
X-Rays: $30.00 copay - $90.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - $140.00 copay
Diagnostic Radiological Services: $30.00 copay - $380.00 copay
Out-of-Network:
Lab Services: 40% coinsurance
X-Rays: 40% coinsurance
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: 40% coinsurance
Diagnostic Radiological Services: 40% coinsurance
Home Health Care
In-Network:
$0.00 copay
Out-of-Network:
40% coinsurance
Mental Health Inpatient Care
In-Network:
Days 1-5: $380.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Out-of-Network:
40% coinsurance per stay
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: $30.00 copay
Out-of-Network:
$60.00 copay
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: $380.00 copay
Observation Services: $380.00 copay
Ambulatory Surgical Center: $330.00 copay
Out-of-Network:
Outpatient Hospital - Surgery: 50% coinsurance
Observation Services: 50% coinsurance
Ambulatory Surgical Center: 50% coinsurance
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $30.00 copay
Out-of-Network:
40% coinsurance
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - $30.00 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:
40% coinsurance per stay

Dental Benefits

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

Coverage Cost
Dental Care
This plan covers up to a $1,500 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

Out-of-Network:
Medicare Covered Dental: $0.00 copay
Non-Medicare Preventive Dental Services: 20% coinsurance
Non-Medicare Comprehensive Dental Services: 50% 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 - $30.00 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 $275 for eyeglasses or contact lenses every year.
Out-of-Network:
Medicare Covered Eye Exam: $60.00 copay
Routine Eye Exam: $0.00 copay
Medicare Covered Eye Wear: $60.00 copay
Routine 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: $30.00 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.
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

Prescription Drug Costs and Coverage

The Anthem Grocery (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $295 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $295 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $295 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $295 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
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