A non-government entity
Anthem I PathWays Dual Care Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I PathWays Dual Care 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 I PathWays Dual Care Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem I PathWays Dual Care 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 I PathWays Dual Care 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 I PathWays Dual Care 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 I PathWays Dual Care 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 I PathWays Dual Care Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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:
Sign up for Anthem I PathWays Dual Care Advantage (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem I PathWays Dual Care Advantage (HMO D-SNP) prescription drug plan has an annual deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, a 25% coinsurance applies to all supply lengths at standard pharmacies and mail order. Tier 5 specialty drugs also carry a 25% coinsurance, which is restricted to a one-month supply. These standard rates help you easily estimate your out-of-pocket costs for brand-name and specialty prescriptions.
Additional Benefits
The Anthem I PathWays Dual Care Advantage (HMO D-SNP) offers robust medical coverage with many essential services featuring no copays. Members pay no copay or coinsurance for inpatient hospital stays, skilled nursing facility care, home health services, and routine preventive care. However, outpatient hospital care, primary care visits, specialist consultations, and diagnostic tests generally require a 20% coinsurance with no copay. This plan also provides valuable supplemental coverage, including comprehensive dental care up to $2,500 annually and routine vision services with no copays or coinsurance. Additionally, members benefit from up to 60 free one-way transportation trips per year, hearing aid coverage up to $2,000, and fully covered over-the-counter items. Emergency room visits require a $115 copay, while urgent care services are available for a $20 copay.
Inpatient Hospital See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) partially covers inpatient hospital services, providing acute and psychiatric care with no copay and no coinsurance, subject to prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance, providing up to 60 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, podiatry, and opioid treatment services with no copay and a 20% coinsurance. Additional telehealth benefits are covered with no copay and no coinsurance, though chiropractic services are not covered and prior authorization is required for most specialized services.
Preventive Services See details
Preventive Services are covered by Anthem I PathWays Dual Care Advantage (HMO D-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, and select supplemental benefits like fitness and home safety devices. The plan partially covers other services, requiring a 20% coinsurance and no copay for glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs, while benefits such as health education and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by Anthem I PathWays Dual Care Advantage (HMO D-SNP) with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $2,000 annually and OTC hearing aids up to $300 annually with no copays or coinsurance, though prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Anthem I PathWays Dual Care Advantage (HMO D-SNP), excluding other eye exams and eyewear upgrades. Covered routine eye exams (one per year) and contact lenses have no copay and a 20% coinsurance, while eyeglasses have no copay and no coinsurance, all with no deductibles and a combined $300 annual limit for eyewear.
Dental Services See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for preventive and comprehensive care up to a $2,500 annual limit, although Medicare-covered dental services require a 20% coinsurance and no copay. Implant services, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem I PathWays Dual Care Advantage (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Anthem I PathWays Dual Care Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Anthem I PathWays Dual Care Advantage (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Anthem I PathWays Dual Care 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 I PathWays Dual Care Advantage (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, though some services are covered while specific sub-services are not. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by the plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem I PathWays Dual Care Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows for admission without a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Anthem I PathWays Dual Care Advantage (HMO D-SNP), offering no copay and no coinsurance for over-the-counter (OTC) items, chronic illness meal benefits, and Medicare community resource support. Acupuncture and highly integrated services for dual-eligible SNPs are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved