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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 2025, 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 2025.
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 $25.80. 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 $590.00 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 $9350.00 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 has a $590 deductible for prescription drugs. After meeting the deductible, your drug costs will vary depending on the specific drug tier and pharmacy you use, but these costs are not listed in the provided information. If you qualify for the low-income subsidy, you will pay $25.80 per month for Part D coverage. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a variety of benefits beyond Original Medicare. This plan includes coverage for outpatient services, with a 20% coinsurance for outpatient hospital and observation services, and no copay for outpatient blood services. You'll also find coverage for emergency services with a $90 copay, as well as primary care, preventive services, hearing, vision, and dental services with varying cost-sharing structures. This plan also provides coverage for ambulance and transportation services, home infusion, dialysis, medical equipment, and diagnostic services. Additionally, there are no copays for home health services, and other services such as OTC items and meal benefits. However, the plan does not cover cardiac rehabilitation services, and the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with coinsurance costs as defined by Original Medicare, but additional days, non-Medicare covered stays, and upgrades for these services are not covered. Prior authorization is required for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services have no copay. Ambulatory surgical center services and outpatient substance abuse services have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage (HMO D-SNP) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground and air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Anthem Full Dual Advantage (HMO D-SNP). Emergency Services have a $90 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have no copay. Worldwide Emergency Transportation, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Mental Health Specialty Services have a 20% coinsurance. Chiropractic Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services have a 20% coinsurance. Podiatry Services has a 20% coinsurance for routine foot care and no copay for Medicare-covered Podiatry Services. Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Annual physical exams have no copay, while additional preventive services may have a copay. Other preventive services have a 20% coinsurance for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, up to a maximum of $3000 per year. OTC hearing aids are covered with no copay, up to a maximum of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams have no copay, and other eye exams have a copay. Eyewear includes a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, but DME for use outside the home is not covered. Prosthetics and Medical Supplies have no copay and a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1, though specific copay and coinsurance information is not provided.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and Medicare Community Resource Support with no copay, while acupuncture is not covered. This plan provides up to $180 per month for OTC items.
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