Anthem Veteran (PPO) 2026 Plan Details for Saint Louis County, Missouri Residents
Anthem Veteran (PPO) 2026 Plan Details for Saint Louis County, Missouri Residents
Navigating your Medicare Advantage options in Saint Louis County for 2026 can be overwhelming, but we're here to help. With Anthem Veteran (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 362 Medicare beneficiaries are enrolled in this plan, with 82 members in Saint Louis County, MO.
Anthem Veteran Overview
| Plan ID H4909-021-0 Overview | |
|---|---|
| Health Plan ID: | H4909-021-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6751.00 (In-Network) |
| Part B Give Back: | −$70.00 reduction |
| Part D Drug Plan Benefit: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Saint Louis County, MO |
| Insured By: | Anthem Blue Cross and Blue Shield |
Why Choose Anthem Veteran?
This Medicare Advantage PPO plan delivers flexible access to care along with all the standard benefits of Medicare Part A and Part B. With a monthly premium of $0.00, it allows you to see any Medicare-approved provider — though you’ll typically pay less when using in-network doctors and facilities.
Primary care visits have a $0 copay | Out-of-network: 30% coinsurance, specialist visits come with a $45 copay | Out-of-network: 30% coinsurance, lab services cost {lab_services_cost}, urgent care services carry a $25 copay, and ambulance transportation is $340 copay | Out-of-network: $340 copay. These costs count toward the plan’s annual maximum out-of-pocket (MOOP) limit of $6751.00. Once you reach that limit, in-network care is fully covered for the rest of the year.
Officially listed as CMS plan H4909-021-0. Below, you’ll find a breakdown of cost sharing for key services. Still have questions? Check the FAQ section for more information.
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Out-of-Pocket Expenses
Anthem Veteran has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H4909-021-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 30% coinsurance |
| Specialist: | In-network: $45 copay | Out-of-network: 30% coinsurance |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| 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): | In-network: $0 copay | Out-of-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $115 copay |
| Wordwide emergency care: | $115 copay |
| Urgent care: | $25 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $360 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | 30% 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: | 30% per stay |
| Ground ambulance: | In-network: $340 copay | Out-of-network: $340 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 | $360 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | 30% per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 30% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 30% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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: $90-$110 copay | Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$100 copay | Out-of-network: 30% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| 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: $0 copay |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay | Out-of-network: $0 copay |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay | Out-of-network: $0 copay |
Certain preventive services are covered 100% by Anthem Veteran as a Part B benefit.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Anthem Veteran?
To qualify for enrollment in Anthem Veteran, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Anthem Veteran and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in Anthem Veteran?
Understanding the right time to enroll in Anthem Veteran is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Anthem Veteran
Enrolling in Anthem Veteran is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Anthem Veteran through the official Medicare website.
- Directly with Anthem Veteran: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H4909-021-0:
Is there a premium for this plan in 2026?
For 2026, the monthly premium is $0.00, and you still pay your Part B premium to Medicare.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $6751.00, protecting you from larger bills once you hit that limit.
How is this plan rated by Medicare?
CMS rates it ★3.5 out of 5 stars for 2026.
Is Anthem Veteran popular?
Enrollment stands at roughly 362 members.
Contact Anthem Blue Cross and Blue Shield
| Contact Type | Details |
|---|---|
| Website: | Anthem Blue Cross and Blue Shield Plan Page |
| New Members: | 1-833-668-2247 |
| Existing Members: | 1-833-681-2635 |
| Plan Address: | 1351 William Howard Taft | CN14B-818 | Cincinnati, OH 45206 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Anthem Blue Cross and Blue Shield, http://shop.anthem.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, HealthSpring℠, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint