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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 2025 to people living in Select counties in Missouri. This plan received an overall rating of 3.5 out of 5 stars in 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 $33.40. 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) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled through standard pharmacies or standard mail order. This coverage applies to one-month, two-month, and three-month supplies of these medications. For other drug tiers, including Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for up to a three-month supply. Tier 5 specialty drugs also carry a 25% coinsurance, which is restricted to a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copays for inpatient hospital stays, primary care, and home health services, though a 20% coinsurance typically applies to outpatient care, diagnostic tests, and specialist visits. Emergency care is covered with a $115 copay and urgently needed services with a $20 copay, both with no coinsurance. Additionally, the plan includes essential transportation benefits, offering up to 96 one-way trips to approved locations with no copay and no coinsurance. Members also receive robust supplemental benefits, including up to $3,500 annually for dental care and up to $3,000 for prescription hearing aids with no copays or coinsurance. Vision benefits feature an annual eyewear allowance of up to $425 with no deductible, while routine eye exams require a 20% coinsurance and no copay. Additional perks include a $160 monthly allowance for over-the-counter items and up to $500 annually for home safety modifications, all with no copays and no coinsurance.
Inpatient Hospital See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Specific sub-services including additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization apply 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
Anthem Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
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, requiring prior authorization. Transportation services are partially covered, providing up to 96 one-way trips per year to plan-approved locations with no copay and no coinsurance, 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 of $100,000.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and podiatry services with no copay and 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance.
Preventive Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partially covered preventive services, offering annual physical exams, kidney disease education, and select fitness benefits with no copay and no coinsurance. While sub-services like health education and weight management are not covered, home safety modifications are covered up to $500 annually with no copay and no coinsurance, and specific screenings like glaucoma require a 20% coinsurance and no copay.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, featuring routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over the ear types are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Vision services are partially covered by Anthem Full Dual Advantage (HMO D-SNP), with no coverage for other eye exams or eyewear upgrades. Routine eye exams are covered once yearly with 20% coinsurance and no copay, while eyewear is covered up to $425 annually with no deductible, offering eyeglasses with no copay or coinsurance and contact lenses with 20% coinsurance and no copay.
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 care, plus other dental services with no copay and no coinsurance up to a $3,500 annual limit. Covered benefits include preventive and restorative care, but maxillofacial prosthetics, implant services, 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 may be required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Full Dual Advantage (HMO D-SNP) with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME features 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment has no coinsurance.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO 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 outpatient diagnostic and imaging services.
Home Health Services See details
Anthem 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
Anthem Full Dual Advantage (HMO D-SNP) indicates some services are covered for cardiac rehabilitation with no copay and prior authorization required, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and Medicare-defined coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the Medicare-covered limit 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 $160 monthly over-the-counter allowance, chronic illness meal benefits, and community resource support, while acupuncture is not covered.
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