Anthem Veteran (PPO) Medicare Advantage Plan H4036-024 • 2027
CMS Rating:
Not yet rated by CMS.
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6751.00In-network
- Part B Giveback
- −$95.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 546 beneficiaries
Last update:
Anthem Veteran (PPO) Introduction
This Medicare Advantage PPO plan, Anthem Veteran, is offered by Anthem Blue Cross and Blue Shield and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $6751.00. The plan is identified by CMS Plan ID H4036-024.
Plan Benefits
Cost-sharing for Anthem Veteran includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H4036-024.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $15 copay Out-of-network: 30% coinsurance |
In-network: $15 copay Out-of-network: 30% coinsurance |
| Specialist | In-network: $45 copay Out-of-network: 30% coinsurance |
In-network: $45 copay Out-of-network: 30% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay |
Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $50-$275 copay Out-of-network: 30% coinsurance |
In-network: $50-$275 copay Out-of-network: 30% coinsurance |
| Lab services | In-network: $0-$50 copay Out-of-network: 30% coinsurance |
In-network: $0-$50 copay Out-of-network: 30% coinsurance |
| Outpatient x-rays | In-network: $75-$110 copay Out-of-network: 30% coinsurance |
In-network: $75-$110 copay Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$100 copay Out-of-network: 30% coinsurance |
In-network: $0-$100 copay Out-of-network: 30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $25 copay | $25 copay |
| Inpatient hospital care | In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 30% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 30% per stay |
| Ground ambulance | In-network: $290 copay Out-of-network: $290 copay |
In-network: $290 copay Out-of-network: $290 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $40 copay Out-of-network: 30% coinsurance |
In-network: $40 copay Out-of-network: 30% coinsurance |
| Outpatient group therapy | In-network: $40 copay Out-of-network: 30% coinsurance |
In-network: $40 copay Out-of-network: 30% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Periodontics | In-network: 25% coinsurance Out-of-network: 50% coinsurance |
In-network: 25% coinsurance Out-of-network: 50% coinsurance |
| Endodontics | In-network: 25% coinsurance Out-of-network: 50% coinsurance |
In-network: 25% coinsurance Out-of-network: 50% coinsurance |
| Restorative services | In-network: 25% coinsurance Out-of-network: 50% coinsurance |
In-network: 25% coinsurance Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 25% coinsurance Out-of-network: 50% coinsurance |
In-network: 25% coinsurance Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Prescription hearing aids | In-network: $0 copay Out-of-network: 80% coinsurance You can choose for this plan to cover either your prescription or over-the-counter hearing aids each year, but not both. |
In-network: $0 copay Out-of-network: $0 copay |
| OTC hearing aids | In-network: $0 copay Out-of-network: 80% coinsurance You can choose for this plan to cover either your prescription or over-the-counter hearing aids each year, but not both. |
In-network: $0 copay Out-of-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Anthem Veteran as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H4036)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Anthem Blue Cross and Blue Shield
- Website
- Anthem Blue Cross and Blue Shield Plan Page
- Providers
- Anthem Blue Cross and Blue Shield Providers Page
- Formulary
- Anthem Blue Cross and Blue Shield Formulary Page
- Pharmacy
- Anthem Blue Cross and Blue Shield Pharmacy Page
- New Member Health Plan Help
- (833)668-2197
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Anthem Veteran (H4036-024-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Anthem Veteran (PPO)
What is the monthly premium for Anthem Veteran (PPO)?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H4036-024?
For 2027, the in-network maximum out-of-pocket is $6751.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H4036-024?
Total enrollment is 546 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H4036-024?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Anthem Blue Cross and Blue Shield (official source) | http://shop.anthem.com/medicare | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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