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Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MyCare Ohio 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 I MyCare Ohio Full Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem I MyCare Ohio 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 Select counties in OH. The overall rating for this plan is not yet available for 2026.
It's important to know that Anthem I MyCare Ohio 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 I MyCare Ohio 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 I MyCare Ohio 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 I MyCare Ohio Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.70. 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 I MyCare Ohio Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled through standard pharmacies or standard mail order services. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance for one-month, two-month, and three-month supplies. Tier 5 specialty tier drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage featuring no copays and no coinsurance for inpatient hospital stays, home health care, and skilled nursing facility services. For primary care, specialist consultations, and outpatient services, members generally face no copay but will pay a 20% coinsurance. Emergency care requires a $115 copay, while urgently needed care has a $20 copay, both with no coinsurance. This plan also provides robust supplemental benefits, including dental, vision, and hearing services that feature no copays and varying coinsurance rates up to specific annual limits. Additionally, members can access unlimited one-way transportation to plan-approved locations, select over-the-counter items, and routine physicals with no copay and no coinsurance. Most medical equipment and diagnostic services are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Inpatient hospital services are covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem I MyCare Ohio Full Dual 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 covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem I MyCare Ohio Full Dual 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 copays or coinsurance, up to a $100,000 maximum benefit limit.
Primary Care See details
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) covers primary care, specialist visits, physical therapy, and mental health services with no copay and a 20% coinsurance, though chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance, while most other services require prior authorization.
Preventive Services See details
Preventive services are partially covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP), offering no copay and no coinsurance for annual physicals, kidney disease education, and select supplemental tools like PERS. Several sub-services are not covered, including health education, nutritional therapy, in-home support, and alternative therapies, while covered screenings like glaucoma and diabetes self-management require a 20% coinsurance and no copay.
Hearing Services See details
Hearing services are partially covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP), offering routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids have no copay or coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over-the-ear models are not covered. OTC hearing aids are also covered with no copay or coinsurance up to a $300 yearly limit.
Vision Services See details
Vision services are partially covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP), with other eye exam services and eyewear upgrades excluded from coverage. Routine eye exams are covered once per year with no copay and 20% coinsurance, while eyewear is covered up to $350 annually with no deductible, featuring no copays, no coinsurance for eyeglasses, and 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP), with Medicare-covered dental requiring no copay and 20% coinsurance. Other preventive and comprehensive dental services feature no copay and no coinsurance, though fluoride treatment, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME requires 0% to 20% coinsurance, Medicare-covered prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment and supplies have no coinsurance.
Diagnostic and Radiological Services See details
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with a 20% coinsurance and no copay, though prior authorization is required. Covered benefits include lab services, diagnostic procedures, therapeutic and diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Anthem I MyCare Ohio 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
Cardiac Rehabilitation Services are covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) with no copay and prior authorization required, although only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. While a three-day prior inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) partially covers other services, offering over-the-counter items, chronic illness meal benefits, and Medicare community resource support with no copay and no coinsurance. Acupuncture is not covered under this plan.
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