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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 2025, 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 2025.
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 $590.00 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 $14000.00 (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 $14000.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay coinsurance for your prescriptions. In the initial coverage phase, you will pay 20% to 25% coinsurance for most drugs depending on the tier and pharmacy, and no copay for specialty tier drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Dual Advantage (PPO D-SNP) plan offers a wide range of benefits with varying costs. Many services have no copay, including preventive services, routine hearing exams, contact lenses, and over-the-counter items. However, some services, such as outpatient services, primary care, and vision services, have a coinsurance of up to 20%. Emergency services have a copay, with some services such as worldwide emergency services having no copay. The plan also covers dental services, with no copay for many services, and a maximum benefit of $2500 per year. Inpatient hospital stays and skilled nursing facilities are covered, but may require prior authorization and have associated copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Anthem Dual Advantage (PPO D-SNP) plan, though additional days, non-Medicare covered stays, and upgrades for both are not covered. You will pay the Medicare-defined coinsurance.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the Anthem Dual Advantage (PPO D-SNP) plan. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem Dual Advantage (PPO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services with no copay. Transportation services to any health-related location are not covered, but transportation to plan-approved health-related locations are covered for up to 48 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, there is a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Anthem Dual Advantage (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services all have a 20% coinsurance. Occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services also have a 20% coinsurance. Podiatry services have a 20% coinsurance. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, as well as no copay for Personal Emergency Response Systems, Fitness Benefits, and Remote Access Technologies. Other preventive services have a 20% coinsurance for services including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids have no copay, and OTC hearing aids have no copay. Prescription hearing aids have a maximum benefit of $3000 per year, and OTC hearing aids have a maximum benefit of $300 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, with routine eye exams having no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, and upgrades are not covered.
Dental Services See details
The Anthem Dual Advantage (PPO D-SNP) plan covers dental services, including oral exams, dental X-rays, and other diagnostic and preventative services with no copay. Medicare Dental Services require prior authorization and have a 20% coinsurance. Other Dental Services have a maximum benefit of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay for Medicare Part B drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Dual Advantage (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Dual Advantage (PPO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home health services are covered by the Anthem Dual Advantage (PPO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Anthem Dual Advantage (PPO D-SNP) plan, but the specific services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Dual Advantage (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Anthem Dual Advantage (PPO D-SNP) plan covers over-the-counter items with no copay, a maximum benefit of $260 every three months, and offers Nicotine Replacement Therapy (NRT) and Naloxone coverage. Other services like acupuncture, meal benefits, and other services are also covered with no copay. However, many other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services are not covered.
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