A non-government entity
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 2026, 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 2026 to people living in State of Connecticut. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $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:
Sign up for Anthem Dual Advantage (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Dual Advantage (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled through a standard pharmacy or standard mail order. This cost sharing applies to one-month, two-month, and three-month supplies. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for one-month, two-month, and three-month fills. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply at standard pharmacies and mail order.
Additional Benefits
The Anthem Dual Advantage (PPO D-SNP) plan offers comprehensive coverage for core medical needs, frequently featuring no copays alongside a standard 20% coinsurance for primary care, specialist visits, and outpatient services. For hospital care, inpatient stays require a $305 daily copay for the first five days with no copay for subsequent days, while emergency room visits carry a $115 copay. Beyond basic medical care, members enjoy additional benefits like dental, vision, and hearing coverage, which generally feature no copays and up to 20% coinsurance alongside generous annual maximums. The plan also includes valuable daily-living support with no copays or coinsurance, such as home health services, up to 60 one-way transportation trips per year, and a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Anthem 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 days 6 and beyond. This benefit is partially covered, as prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem Dual Advantage (PPO D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Anthem 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 this benefit.
Ambulance and Transportation Services See details
Anthem Dual Advantage (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also covers up to 60 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to non-approved health locations is not covered.
Emergency Services See details
Anthem 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 maximum benefit limit of $100,000.
Primary Care See details
Anthem Dual Advantage (PPO D-SNP) covers primary care, specialist, mental health, psychiatry, therapy, and opioid treatment services with no copay and 20% coinsurance, while chiropractic and podiatry services are not covered. Additional telehealth benefits are offered with no copay and no coinsurance for select services.
Preventive Services See details
Anthem Dual Advantage (PPO D-SNP) preventive services are partially covered, offering annual physicals, kidney disease education, fitness benefits, PERS, and remote access technologies with no copay and no coinsurance. Covered screenings and exams (glaucoma, diabetes training, digital rectal, and EKGs) carry no copay and a 20% coinsurance, while excluded sub-services include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem Dual Advantage (PPO D-SNP) covers hearing exams and hearing aids with no deductibles, including routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually (inner ear, outer ear, and over the ear devices are not covered), while over-the-counter hearing aids are covered with no copay or coinsurance up to $300 per year.
Vision Services See details
Anthem Dual Advantage (PPO D-SNP) provides partially covered vision services with no deductibles, offering routine eye exams and eyewear with no copays, though a 20% coinsurance applies to routine exams and contact lenses. Annual benefits are capped at $69 for exams and a combined $300 for eyewear, while other eye exam services and upgrades are not covered.
Dental Services See details
Anthem Dual Advantage (PPO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance, while other preventive and comprehensive dental services are partially covered with no copay and no coinsurance up to a $1,200 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Anthem Dual Advantage (PPO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Anthem Dual Advantage (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Dual Advantage (PPO D-SNP) with no copays, although coinsurance and prior authorization requirements apply to certain items. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Dual Advantage (PPO D-SNP) covers diagnostic and radiological services, including lab tests, X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Anthem Dual Advantage (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Dual Advantage (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though only some services are covered in practice. Specific services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (PPO D-SNP) covers Skilled Nursing Facility (SNF) services for up to 100 days with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Dual Advantage (PPO D-SNP) partially covers other services with no copay and no coinsurance, which includes over-the-counter items up to $72 every three months, chronic illness meal benefits, and Medicare community resource support. Acupuncture is not covered under these services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved