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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 Indiana. 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 $39.30. 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 $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy, your monthly premium for Part D will be $39.30. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying costs. Many services, such as routine eye exams, home health services, and preventive services, are available with no copay. You'll also find that many other services, including outpatient substance abuse services, primary care, and dental services, have a coinsurance, which means you pay a percentage of the cost. This plan covers a variety of services with a coinsurance, including outpatient services, specialist visits, and vision and hearing services. Emergency services have a $110 copay, while urgently needed services have a $20 copay. Additionally, the plan provides coverage for prescription hearing aids, medical equipment, and other services with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered, but additional days, non-Medicare covered stays, and upgrades for both are not covered. The plan requires prior authorization for these services, and coinsurance applies.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance for outpatient hospital services and observation services, and Ambulatory Surgical Center (ASC) Services with a 20% coinsurance. Outpatient Substance Abuse Services, including individual and group sessions, are covered with a 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. This benefit has 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 with a 20% coinsurance, and transportation services to a plan-approved health-related location with 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. Emergency Services have a $110 copay, while Urgently Needed Services have a $20 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services (with 20% coinsurance), occupational therapy services (with 20% coinsurance), physician specialist services (with 20% coinsurance), mental health specialty services (with 20% coinsurance), podiatry services (with 20% coinsurance), other health care professional services (with 20% coinsurance), psychiatric services (with 20% coinsurance), physical therapy and speech-language pathology services (with 20% coinsurance), additional telehealth benefits (with no copay), and opioid treatment program services (with 20% coinsurance). Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, including glaucoma screening, diabetes self-management training, and more, are covered with a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with at most 20% coinsurance for routine hearing exams, as well as no copay for fitting/evaluation for hearing aids. Prescription hearing aids have no copay, and OTC hearing aids have no copay, with a maximum benefit of $3,000 and $300, respectively, every year. Prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay and no coinsurance, while eyewear has a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Eyeglass frames also have no copay. Upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare Dental Services with 20% coinsurance and other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. You are responsible for 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for these services, but you may have to pay up to 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1, though more details on coinsurance are available.
Other Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers over-the-counter (OTC) items with no copay, meal benefits with no copay, and Medicare Community Resource Support with no copay; however, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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