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Anthem I PathWays Dual Care Advantage NFLOC (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 NFLOC (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 NFLOC (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem I PathWays Dual Care Advantage NFLOC (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 NFLOC (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 NFLOC (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 NFLOC (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 NFLOC (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 NFLOC (HMO D-SNP)
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Drug Coverage
The Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, a 25% coinsurance applies to all supply durations. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply for both standard retail and mail-order fills.
Additional Benefits
The Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) plan offers comprehensive coverage featuring no copays for several key services, including inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, primary and specialist visits, diagnostic tests, and dialysis, you will generally pay no copay but will be responsible for a 20% coinsurance. Emergency room visits require a $115 copay, while urgent care visits have a $20 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental care up to $4,000 annually and routine vision and hearing services with no copays, though some coinsurance or annual limits may apply. Additionally, members can access up to 150 one-way trips per year for plan-approved transportation and receive diabetic supplies, over-the-counter items, and fitness benefits with no copays or coinsurance.
Inpatient Hospital See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) offers partial coverage for inpatient hospital services, providing acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. Additional hospital days, room upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Anthem I PathWays Dual Care Advantage NFLOC (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 and no coinsurance for up to 150 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem I PathWays Dual Care Advantage NFLOC (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 up to a $100,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, though prior authorization is typically required. Telehealth services are available with no copay and no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers annual physical exams, kidney disease education, and select supplemental services like fitness and PERS with no copay and no coinsurance, though several other supplemental benefits are not covered. Other preventive services, including glaucoma screenings and diabetes self-management training, are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP), which offers routine hearing exams and fitting evaluations with no copay and a 20% coinsurance on routine exams, though Medicare-covered exams require a copay. Prescription hearing aids are covered with no copay or coinsurance up to a $3,000 annual limit—excluding inner ear, outer ear, and over-the-ear types which are not covered—while OTC hearing aids have no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Vision services are partially covered by Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP), which offers one routine eye exam per year with no copay, 20% coinsurance, and no deductible. Eyewear is covered up to a $300 annual limit with no deductible, featuring no copay for eyeglasses, lenses, and frames, and 20% coinsurance for contact lenses, though other eye exams and eyewear upgrades are not covered.
Dental Services See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $4,000 annual maximum. While preventive and most comprehensive treatments are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem I PathWays Dual Care Advantage NFLOC (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 and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, while prosthetics and medical supplies are covered 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 by Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include diagnostic procedures, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) plan with no copay and prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) covers skilled nursing facility services with no copay and no coinsurance, though prior authorization is required. While a three-day prior inpatient hospital stay is not required for admission, 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 NFLOC (HMO D-SNP), featuring over-the-counter (OTC) items, limited-duration meal benefits for chronic illnesses, and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and other select services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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