Anthem Medicare Advantage 4 (PPO)

Anthem Blue Cross and Blue Shield
Anthem Medicare Advantage 4 (PPO) H4036-038 Plan Details
4 out of 5 stars

Anthem Medicare Advantage 4 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-038

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 Medicare Advantage 4 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-038

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 4 (PPO) H4036-038 Plan Details
4 out of 5 stars

Anthem Medicare Advantage 4 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-038

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

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $9350
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% coinsurance
Specialty Doctor Visit
In-Network:
$45.00 copay
Out-of-Network:
40% coinsurance
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: $30.00 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: $260.00 copay Per Trip
Air Ambulance: $260.00 copay

Health Care Services and Medical Supplies

Anthem Medicare Advantage 4 (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: 40% coinsurance
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: $50.00 copay - $130.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - $95.00 copay
Diagnostic Radiological Services: $50.00 copay - $380.00 copay
Out-of-Network:
Lab Services: 40% coinsurance
X-Rays: 40% coinsurance
Therapeutic Radiological Services: 40% 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: $45.00 copay
Out-of-Network:
40% coinsurance
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: 40% coinsurance
Observation Services: 40% coinsurance
Ambulatory Surgical Center: 40% coinsurance
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $45.00 copay
Out-of-Network:
40% coinsurance
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - $45.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Out-of-Network:
Medicare Covered Podiatry Services: 40% coinsurance
Routine Foot Care: 40% coinsurance
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 - $45.00 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 $200 for eyeglasses or contact lenses every year.
Out-of-Network:
Medicare Covered Eye Exam: 40% coinsurance
Routine Eye Exam: $0.00 copay
Medicare Covered Eye Wear: $0.00 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: $45.00 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 $3,000 maximum plan benefit for prescribed hearing aids every year.
Out-of-Network:
Medicare Covered Hearing Exam: 40% 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
Out-of-Network:
40% coinsurance