Medicare Advantage Plan R5941-013-0 in Adams County, OH
Anthem Veteran (PPO) • 2026
Medicare Advantage Plan R5941-013-0 in Adams County, OH Anthem Veteran (PPO) • 2026
Plan-ID R5941-013-0 refers to Anthem Veteran (Regional PPO), a Medicare Advantage Plan (Part C) offered by Anthem Blue Cross and Blue Shield for the 2026 plan year. This plan is a Preferred Provider Organization (PPO) model without Part D prescription drug coverage.
According to CMS enrollment data, an estimated 676 beneficiaries are enrolled in this plan, 0 enrollees reside in Adams County.
Anthem Veteran Overview
| Plan ID R5941-013-0 Overview | |
|---|---|
| Health Plan ID: | R5941-013-0 |
| Medicare Advantage Plan Type: | Regional PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $4900.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Adams County, OH |
| Insured By: | Anthem Blue Cross and Blue Shield |
Why Consider Anthem Veteran?
This Medicare Advantage Preferred Provider Organization (PPO) plan gives you broad access to care and the flexibility to choose any Medicare-approved provider. With a monthly premium of $0.00, Anthem Veteran includes all benefits under Medicare Part A and Part B — and offers lower costs when you stick to the plan’s network.
Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, specialist visits come with a $35 copay | Out-of-network: 50% coinsurance, lab services cost {lab_services_cost}, urgent care services carry a $25 copay, and ambulance transportation is $275 copay | Out-of-network: $275 copay. These costs apply toward your annual maximum out-of-pocket (MOOP) limit of $4900.00. After reaching that limit, all in-network care is covered in full.
You’ll find this plan listed by CMS as R5941-013-0. Cost-sharing details for key services are outlined below. Still have questions? Check the FAQ section to learn more.
We're Here to Help You Enroll
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 R5941-013-0.
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Specialist: | In-network: $35 copay | Out-of-network: 50% coinsurance |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| 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): | Not covered |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $50-$255 copay | Out-of-network: 50% coinsurance |
| Lab services: | In-network: $0-$15 copay | Out-of-network: 50% coinsurance |
| Outpatient x-rays: | In-network: $90-$110 copay | Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$150 copay | Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $25 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $255 per day for days 1-8 | $0 per day for days 9-90 | $0 per stay | Out-of-network: | 50% 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: | 50% per stay |
| Ground ambulance: | In-network: $275 copay | Out-of-network: $275 copay |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $35 copay | Out-of-network: 50% coinsurance |
| Outpatient group therapy: | In-network: $35 copay | Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $255 per day for days 1-8 | $0 per day for days 9-90 | $0 per stay | Out-of-network: | 50% per stay |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $35 copay | Out-of-network: 50% coinsurance |
| Occupational therapy: | In-network: $35 copay | Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-50% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-50% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| 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
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| 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 coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| 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-related hair loss: | Not covered |
| 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.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
How CMS Star Ratings Guide Your Choice
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| 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 R5941-013-0:
What’s the monthly premium for Anthem Veteran (Regional PPO)?
The 2026 premium is $0.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $4900.00, protecting you from larger bills once you hit that limit.
Is this a 4-star or 5-star plan?
For 2026, plan R5941-013-0 has a ★3.5 rating. The best rating is 5 stars.
Is Anthem Veteran popular?
Enrollment stands at roughly 676 members.
Contact Anthem Blue Cross and Blue Shield
| Contact Type | Details |
|---|---|
| Website: | Anthem Blue Cross and Blue Shield Plan Page |
| New Members: | 1-833-668-2393 |
| Existing Members: | 1-800-467-1199 |
| Plan Address: | 1351 William Howard Taft Road | 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, https://shop.anthem.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Understanding 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, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
You can compare Plan-ID R5941-013 with the full list of 2026 Medicare Advantage plans, organized by state and county.
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