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Anthem Dual Advantage (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Dual Advantage (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Dual Advantage (PPO D-SNP) in 2026, please refer to our full plan details page.
Anthem Dual Advantage (PPO D-SNP) is a PPO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Virginia. The overall rating for this plan is not yet available for 2026.
It's important to know that Anthem Dual Advantage (PPO 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 Dual Advantage (PPO 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 Dual Advantage (PPO 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 Dual Advantage (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $520.00 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Dual Advantage (PPO D-SNP) Medicare plan features an annual drug deductible of $520. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This cost-free benefit applies to one-month, two-month, and three-month supplies. For other prescription tiers, you will pay a 25% coinsurance for Tier 2 generic drugs, Tier 3 preferred brand drugs, and Tier 4 non-preferred drugs. Specialty medications in Tier 5 require a 27% coinsurance for a one-month supply at standard pharmacies and through standard mail order. These cost-sharing details help you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Anthem Dual Advantage (PPO D-SNP) plan offers many core medical services with no copay and no coinsurance, including inpatient hospital care, home health services, and telehealth visits. For other essential services like outpatient care, primary care visits, and diagnostic tests, you will pay no copay but are subject to a 20% coinsurance. Emergency room visits carry a $115 copay, while urgent care services require a $40 copay with no coinsurance. Routine dental, vision, and hearing benefits are widely covered with no copays, though certain services may require a 20% coinsurance up to specific annual plan limits. The plan also features no copay and no coinsurance for up to 24 one-way transportation trips per year and a $205 quarterly over-the-counter item allowance. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem Dual Advantage (PPO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered under this benefit.
Outpatient Services See details
Anthem Dual Advantage (PPO D-SNP) covers outpatient services with no copays, featuring a 20% coinsurance and prior authorization requirements for outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Dual Advantage (PPO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Anthem Dual Advantage (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Dual Advantage (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance up to a maximum benefit limit of $100,000.
Primary Care See details
Anthem Dual Advantage (PPO D-SNP) covers primary care, specialist visits, therapy, and mental health services with no copay and 20% coinsurance, though telehealth options feature no copay and no coinsurance. Chiropractic services are not covered under this plan, and prior authorization is required for most specialist and therapy services.
Preventive Services See details
Anthem Dual Advantage (PPO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems. While Medicare-covered screenings like glaucoma and diabetes self-management require a 20% coinsurance and no copay, several options including health education, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered by Anthem Dual Advantage (PPO D-SNP), offering routine exams and fitting evaluations with no copay and a 20% coinsurance for routine exams up to a $59 yearly limit. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $3,000 annual limit, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are covered with no copay and no coinsurance up to a $300 annual limit.
Vision Services See details
Vision services are covered by Anthem Dual Advantage (PPO D-SNP) with no deductible and no copays, though a 20% coinsurance applies to routine eye exams and contact lenses, while eyeglasses have no coinsurance. This partially covered benefit excludes other eye exam services and eyewear upgrades, providing up to $69 annually for one routine exam and a $325 yearly limit for eyewear.
Dental Services See details
Dental services are partially covered by Anthem Dual Advantage (PPO D-SNP), which offers Medicare-covered dental care with no copay and 20% coinsurance, and other preventive and comprehensive dental services with no copay, no coinsurance, up to a $2,500 annual limit. However, implant services, orthodontics, and maxillofacial prosthetics are not covered under this plan.
Home Infusion bundled Services See details
Anthem Dual Advantage (PPO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Dual Advantage (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Dual Advantage (PPO D-SNP) with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization or manufacturer limitations may apply to certain items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Dual Advantage (PPO D-SNP) with no copay, subject to a 20% coinsurance and prior authorization. This coverage includes all outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Anthem Dual Advantage (PPO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Dual Advantage (PPO D-SNP) provides cardiac rehabilitation services with no copay and requires prior authorization, but only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Dual Advantage (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and prior authorization is required.
Other Services See details
Anthem Dual Advantage (PPO D-SNP) partially covers other services with no copay and no coinsurance for chronic illness meal benefits, Medicare Community Resource Support, and up to $205 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
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