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Anthem Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem 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 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 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 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 Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.10. 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 $6750.00 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 Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, 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. This plan design helps members save money on common medications and essential maintenance drugs. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members pay a 25% coinsurance for one, two, or three-month supplies at standard pharmacies and mail order. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply. This straightforward cost-sharing structure helps you easily plan for your medication expenses under the Anthem Dual Advantage (HMO D-SNP) plan.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care, telehealth, and preventive services. For specialized care, members pay no coinsurance and predictable copays, including $25 for specialist visits and $130 for emergency room care. Inpatient hospital stays require daily copays for the first week of a stay, followed by no copays for subsequent days and no coinsurance. Supplemental benefits are a major highlight of this plan, offering dental coverage up to $1,800 and vision exams with eyewear up to $200 with no copays or coinsurance. Members also benefit from routine hearing exams and hearing aid coverage with no copays, alongside up to 24 one-way transportation trips to approved medical locations per year with no copay. Additionally, home health services and diabetic supplies are covered with no copay or coinsurance.
Inpatient Hospital See details
Anthem Dual Advantage (HMO D-SNP) inpatient hospital services are partially covered with no coinsurance, requiring a $435 daily copay for days 1-7 of acute stays and a $390 daily copay for days 1-6 of psychiatric stays, with no copay for subsequent days. Non-Medicare-covered stays and hospital upgrades are not covered under this plan.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $435 copay for outpatient hospital services and a $435 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay, while outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Anthem Dual Advantage (HMO D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a $260 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 24 one-way trips per year 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 Dual Advantage (HMO D-SNP) covers emergency services with a $130 copay and urgently needed services with a $20 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with no copays and no coinsurance.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) covers primary care and telehealth services with no copay and no coinsurance, while specialty, psychiatric, therapy, and opioid treatment services require a $25 copay and no coinsurance. Podiatry and other healthcare professional services have copays ranging up to $25 with no coinsurance, and for chiropractic services, some services are covered but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered by Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and diabetes self-management training. Although some additional benefits like fitness, remote access, home safety modifications, and personal emergency response systems are covered, other services such as health education, medical nutrition therapy, and in-home support are not covered.
Hearing Services See details
Hearing services covered by Anthem Dual Advantage (HMO D-SNP) include Medicare-covered exams for a $25 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $2,000 annually with no copay or coinsurance, excluding inner ear, outer ear, and over-the-ear types, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Dual Advantage (HMO D-SNP) covers vision services with no deductibles or coinsurance, offering one routine eye exam per year and eyewear like contacts and glasses with no copay up to a $200 annual limit. However, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance for covered services, up to a maximum annual benefit of $1,800. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation, have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers medical equipment with no copays, featuring diabetic supplies and therapeutic shoes with no coinsurance. Durable medical equipment has a 0% to 20% coinsurance, while prosthetic devices and medical supplies carry a 20% coinsurance, with both requiring prior authorization.
Diagnostic and Radiological Services See details
Anthem Dual Advantage (HMO D-SNP) covers diagnostic services with prior authorization, offering lab services with no copay and diagnostic tests with no coinsurance and a copay ranging from no copay to $30. Covered radiological services also require prior authorization, featuring a minimum $30 copay for diagnostic radiology, a $50 copay for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem 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 Dual Advantage (HMO D-SNP) with no copay and no coinsurance, and prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers other services with no copay and no coinsurance, including over-the-counter items, chronic illness meal benefits, and Medicare Community Resource Support. Acupuncture is not covered under this benefit.
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