Anthem Veteran (PPO) Medicare Advantage Plan H4036-024 • 2027 • Sheboygan County, WI
- 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
- Sheboygan County, WI
- Local Enrollment
- 41 beneficiaries in Sheboygan County
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.
Enrollment in this plan requires residence in Sheboygan County, Wisconsin. CMS enrollment data reports 41 plan members in Sheboygan County. New members can call the plan directly at (833)668-2197 (TTY 711) for assistance.
Compare Similar Plans in Sheboygan County
Compare this plan with the two most-enrolled PPO plans available in Sheboygan County, Wisconsin. Enrollment is based on CMS local enrollment data.
| Plan Detail | Anthem Veteran | Network Health Select | Network Health Choice |
|---|---|---|---|
| CMS Plan ID | H4036-024-0 |
H5215-008-0 |
H5215-011-0 |
| Local Enrollment | 41 | 2,845 | 1,722 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $200 | $500 |
| Maximum Out-of-Pocket | $6,751.00 | $4,450.00 | $5,100.00 |
| Part B Giveback | −$95.00 reduction | Not offered | Not offered |
| Primary Care | $15 copay | $0 copay | $0 copay |
| Specialist | $45 copay | $60 copay | $50 copay |
| Part D Deductible | Not Applicable | $330.00 | $300.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $10 copay | $10 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
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.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4036-024-0 Cost Compare.
Office Visits
- Primary care
- In-network: $15 copay
Out-of-network: 30% coinsurance - Specialist
- In-network: $45 copay
Out-of-network: 30% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 30% coinsurance - Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: $0 copay - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $50-$275 copay
Out-of-network: 30% coinsurance - Lab services
- In-network: $0-$50 copay
Out-of-network: 30% coinsurance - Outpatient x-rays
- In-network: $75-$110 copay
Out-of-network: 30% coinsurance - Diagnostic tests and procedures
- In-network: $0-$100 copay
Out-of-network: 30% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $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 - 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 - Ground ambulance
- In-network: $290 copay
Out-of-network: $290 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
Out-of-network: 30% coinsurance - Outpatient group therapy
- 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
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
Out-of-network: 30% coinsurance - Occupational therapy
- In-network: $35 copay
Out-of-network: 30% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 30% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Medicare Part B Drugs
- Chemotherapy
- 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
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 20% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 20% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 20% coinsurance - Periodontics
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance - Endodontics
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance - Restorative services
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass frames only
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay - Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 20% coinsurance - Fitting/evaluation
- 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. - 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.
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- 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.
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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