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Anthem Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Full Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem 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 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 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 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 Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.20. 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 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 and Tier 6 Select Care Drugs when using standard retail pharmacies or standard mail order for one, two, or three-month supplies. This coverage helps minimize out-of-pocket expenses for many common and essential medications. For other tiers, you will pay a 25% coinsurance for your prescription drugs. This 25% coinsurance rate applies to Tier 2 Generic, Tier 3 Preferred Brand, and Tier 4 Non-Preferred Drugs for up to a three-month supply, as well as Tier 5 Specialty Tier drugs for a one-month supply. Cost-sharing remains consistent whether you fill your prescriptions at a standard pharmacy or through standard mail order.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) offers robust medical coverage with significant cost savings, featuring no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, primary and specialist visits, and diagnostic services, members generally enjoy no copay alongside a 20% coinsurance. Emergency care is available with a $115 copay, and urgent care has a $20 copay, both with no coinsurance. This plan also provides valuable supplemental benefits with no deductibles, including routine dental care and hearing aids with no copay or coinsurance. Vision care is covered with no copay and a 20% coinsurance, which includes a $300 annual eyewear allowance. Additionally, members benefit from no-cost transportation for up to 108 one-way trips annually to plan-approved locations and a $125 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. However, additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, although a 20% coinsurance and prior authorization are required for outpatient hospital, ambulatory surgical center, and substance abuse services. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 108 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Anthem 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 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance, while additional telehealth benefits feature no copay and no coinsurance. Some chiropractic services are covered, but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partially covered preventive services, including annual physical exams, kidney disease education, and select home safety modifications with no copay and no coinsurance. While several supplemental benefits like health education and nutritional therapy are not covered, other services such as glaucoma screenings and diabetes self-management training are covered with no copay and a 20% coinsurance.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, including Medicare-covered exams and fitting evaluations for no copay. Routine hearing exams have a 20% coinsurance and no copay, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay or coinsurance, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no deductibles, including one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered up to $300 yearly with no copay and no coinsurance for eyeglasses, lenses, and frames, and no copay and 20% coinsurance for contact lenses, though upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for most other preventive and comprehensive dental care. While many diagnostic, restorative, and surgical services are covered, fluoride treatments, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Full Dual Advantage (HMO D-SNP) covers medical equipment with no copays, though coinsurance and prior authorization may be required for some items. Durable medical equipment features a 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic supplies are fully covered with no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, a 20% coinsurance, and prior authorization requirements. While some services are covered, specific benefits including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond those covered by Medicare are not covered.
Other Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers other services with no copay and no coinsurance, providing a chronic illness meal benefit, Medicare Community Resource Support, and a $125 monthly over-the-counter allowance. Acupuncture is not covered under these additional services.
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