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Anthem Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Full Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that Anthem Full Dual Advantage (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Anthem Full Dual Advantage (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Full Dual Advantage (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Anthem Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Anthem Full Dual Advantage (HMO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs. This cost-saving benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for all supply durations. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply. These standard pharmacy and standard mail-order rates help you easily estimate your out-of-pocket prescription costs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage featuring no copays and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, doctor visits, and diagnostic testing, members typically pay no copay but are responsible for a 20% coinsurance. Emergency care is subject to a $115 copay, while urgent care visits require a $20 copay, with no coinsurance for either service. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care up to a $2,000 annual limit with no copay and no coinsurance. Members benefit from routine vision and hearing coverage, including allowances for eyewear and hearing aids with no copays or coinsurance, alongside up to 36 free one-way transportation trips to approved locations. Additionally, diabetic supplies, fitness programs, and over-the-counter items are covered with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, although prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copays, though a 20% coinsurance and prior authorization apply to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Full Dual Advantage (HMO D-SNP) with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Anthem Full Dual Advantage (HMO D-SNP) with a $115 copay and no coinsurance, while urgently needed services are covered with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with no copay and no coinsurance.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and mental health services with no copay and 20% coinsurance, while telehealth services are available with no copay and no coinsurance. Chiropractic services are not covered, and prior authorization is required for most specialty care.
Preventive Services See details
Preventive services under the Anthem Full Dual Advantage (HMO D-SNP) are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, and counseling. Other services, including glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs, are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no deductibles, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. Routine hearing exams require a 20% coinsurance and no copay, while fitting evaluations, prescription hearing aids (up to $2,000 annually), and OTC hearing aids (up to $300 annually) feature no copay and no coinsurance.
Vision Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year with no copay and 20% coinsurance, while other eye exams are not covered. Eyewear is also partially covered up to a $300 annual limit, providing eyeglasses, lenses, and frames with no copay and no coinsurance, and contact lenses with no copay and 20% coinsurance, though upgrades are not covered.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partially covered dental services, with maxillofacial prosthetics, implant services, and orthodontics not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Full Dual Advantage (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies which feature no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance, though manufacturer limitations and prior authorizations may apply.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Full Dual Advantage (HMO D-SNP) offers cardiac rehabilitation services with no copay, but key sub-services including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD are not covered and require a 20% coinsurance and prior authorization.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance for covered benefits like over-the-counter items, meal benefits for chronic illnesses, and Medicare Community Resource Support. Acupuncture is not covered under this plan.
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