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Anthem Full Dual Advantage (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full 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 Full Dual Advantage (PPO D-SNP) in 2026, please refer to our full plan details page.
Anthem Full 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 Connecticut. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Anthem Full 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 Full 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 Full 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 Full Dual Advantage (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.80. 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 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 Full Dual Advantage (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, the plan charges a 25% coinsurance for one-month, two-month, and three-month fills. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Anthem Full Dual Advantage (PPO D-SNP) offers comprehensive healthcare coverage where many services require no copay, though a standard 20% coinsurance applies to outpatient care, doctor visits, and diagnostic services. For inpatient hospital stays and skilled nursing facility care, members are responsible for daily copays during the initial days of a stay but pay no coinsurance. Emergency and urgent care services are covered under flat copays with no coinsurance, ensuring predictable expenses during medical emergencies. Additionally, the plan provides several key benefits with no copay and no coinsurance, including home health services, telehealth visits, and diabetic equipment. Members also benefit from supplemental coverage with no copays or coinsurance, such as routine dental care up to a $1,500 annual limit, routine transportation, and a recurring allowance for over-the-counter items.
Inpatient Hospital See details
Anthem Full Dual Advantage (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $305 daily copay for days 1 through 5 and no copay for day 6 and beyond. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Anthem Full Dual Advantage (PPO D-SNP) covers outpatient services with no copays, 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, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Full Dual Advantage (PPO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Anthem Full 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 copay and no coinsurance, up to a $100,000 maximum plan benefit limit.
Primary Care See details
Anthem Full Dual Advantage (PPO D-SNP) covers primary care, specialist, therapy, mental health, podiatry, and psychiatric services with no copay and 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also covered with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under the Anthem Full Dual Advantage (PPO D-SNP), offering no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness programs. Other preventive benefits, such as glaucoma screenings and diabetes self-management training, are covered with no copay and a 20% coinsurance, while several sub-services like health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Anthem Full Dual Advantage (PPO D-SNP), featuring no deductibles, routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription and OTC hearing aids are covered with no copay or coinsurance up to annual limits of $3,000 and $300 respectively, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Anthem Full Dual Advantage (PPO D-SNP) vision services are partially covered, excluding upgrades and other eye exam services. Covered routine eye exams and eyewear have no copays and no deductibles, though a 20% coinsurance applies to routine exams and contact lenses, up to annual limits of $69 for exams and $350 for eyewear.
Dental Services See details
Dental services are partially covered by Anthem Full Dual Advantage (PPO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance up to a $1,500 annual maximum for both in-network and out-of-network care.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (PPO D-SNP) covers home infusion bundled services with no copay, although prior authorization and step therapy may be required. Associated Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Anthem Full Dual Advantage (PPO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Full Dual Advantage (PPO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies which require no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Anthem Full Dual Advantage (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This coverage applies to outpatient diagnostic procedures, lab services, X-rays, and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Anthem Full Dual Advantage (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under the Anthem Full Dual Advantage (PPO D-SNP), but require prior authorization. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and instead carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Anthem Full Dual Advantage (PPO D-SNP) with no copay and no coinsurance, including Medicare Community Resource Support, chronic illness meal benefits, and up to $150 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
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