Anthem Veteran (PPO) Medicare Advantage Plan H4909-020 • 2027
CMS Rating:
(3.0 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $750
- Maximum Out-of-Pocket
- $6800.00In-network
- Part B Giveback
- −$80.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,166 beneficiaries
Last update:
Anthem Veteran (PPO) Introduction
CMS Plan ID H4909-020 identifies Anthem Veteran, a Medicare Advantage PPO plan offered by Anthem Blue Cross and Blue Shield. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $750 medical deductible, and $6800.00 in-network maximum out-of-pocket.
Plan Benefits
Anthem Veteran has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4909-020.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $35 copay |
In-network: $0 copay Out-of-network: $35 copay |
| Specialist | In-network: $45 copay Out-of-network: $60 copay |
In-network: $45 copay Out-of-network: $60 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 35% 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 |
In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $50-$290 copay Out-of-network: 35% coinsurance |
In-network: $50-$290 copay Out-of-network: 35% coinsurance |
| Lab services | In-network: $0-$15 copay Out-of-network: 35% coinsurance |
In-network: $0-$15 copay Out-of-network: 35% coinsurance |
| Outpatient x-rays | In-network: $50-$110 copay Out-of-network: 35% coinsurance |
In-network: $50-$110 copay Out-of-network: 35% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$140 copay Out-of-network: 35% coinsurance |
In-network: $0-$140 copay Out-of-network: 35% 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 | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $290 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 35% per stay |
In-network: Tier 1 $290 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 35% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 35% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 35% per stay |
| Ground ambulance | In-network: $285 copay Out-of-network: $285 copay |
In-network: $295 copay Out-of-network: $295 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $45 copay Out-of-network: 35% coinsurance |
In-network: $45 copay Out-of-network: 35% coinsurance |
| Outpatient group therapy | In-network: $45 copay Out-of-network: 35% coinsurance |
In-network: $45 copay Out-of-network: 35% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $290 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 35% per stay |
In-network: Tier 1 $290 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 35% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 35% coinsurance |
In-network: $35 copay Out-of-network: 35% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 35% coinsurance |
In-network: $35 copay Out-of-network: 35% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 35% coinsurance |
In-network: $0 copay Out-of-network: 35% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 35% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 35% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 35% coinsurance |
In-network: 20% coinsurance Out-of-network: 35% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-35% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-35% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-35% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-35% 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: H4909)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, 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)668-2247
- 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 (H4909-020-0) is available in the following locations:
Virginia Counties Served
- Albemarle
- Amelia
- Appomattox
- Augusta
- Bath
- Bedford
- Bland
- Botetourt
- Bristol City
- Brunswick
- Buchanan
- Buena Vista City
- Campbell
- Caroline
- Charles City
- Charlotte
- Chesapeake City
- Chesterfield
- Clarke
- Colonial Heights City
- Covington City
- Craig
- Cumberland
- Dickenson
- Dinwiddie
- Emporia City
- Fauquier
- Floyd
- Fluvanna
- Franklin
- Franklin City
- Frederick
- Galax City
- Giles
- Gloucester
- Goochland
- Grayson
- Greene
- Greensville
- Halifax
- Hampton City
- Hanover
- Henrico
- Henry
- Highland
- Isle Of Wight
- King And Queen
- King George
- King William
- Lancaster
- Lee
- Lexington City
- Louisa
- Lunenburg
- Lynchburg City
- Madison
- Manassas City
- Manassas Park City
- Mathews
- Middlesex
- New Kent
- Newport News City
- Norfolk City
- Northampton
- Northumberland
- Norton City
- Nottoway
- Orange
- Page
- Patrick
- Petersburg City
- Poquoson City
- Portsmouth City
- Powhatan
- Prince Edward
- Prince George
- Pulaski
- Radford
- Rappahannock
- Richmond
- Richmond City
- Roanoke
- Roanoke City
- Rockbridge
- Rockingham
- Russell
- Salem
- Scott
- Shenandoah
- Spotsylvania
- Stafford
- Staunton City
- Suffolk City
- Surry
- Tazewell
- Virginia Beach City
- Washington
- Waynesboro City
- Westmoreland
- Williamsburg City
- Winchester City
- Wise
- Wythe
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)
Is there a monthly premium for this plan in 2027?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H4909-020?
The 2027 in-network MOOP is $6800.00. Once this limit is reached, covered in-network costs are fully covered.
How many beneficiaries are enrolled in this plan?
CMS reports 1,166 beneficiaries enrolled in this plan.
What is the Part D deductible for plan H4909-020?
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 | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 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 | Explore your Medicare coverage options | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.