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Anthem Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem 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 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 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 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 Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.60. 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 $4200.00 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 Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay the cost-sharing amount for your drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $35.60 for Part D.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $350 copay for days 1-6 and no copay for the rest, while outpatient services may have copays ranging from $0 to $350. Emergency services have a $125 copay, and primary care visits have no copay, with specialist visits costing $30. Preventive services, including an annual physical exam, are covered with no copay. The plan also includes hearing, vision, and dental benefits, with hearing aids covered up to $3,000 per year and dental services up to $2,500 per year, both with no copay. Home infusion, dialysis, and medical equipment are covered with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For inpatient hospital-acute and inpatient hospital-psychiatric stays, you will pay a $350 copay for days 1-6 and no copay for days 7-90; additional days for both are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services cover a range of services, including outpatient hospital services with a copay of $0-$350, observation services with a copay of $350, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Dual Advantage (HMO D-SNP) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay and are limited to 60 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by Anthem Dual Advantage (HMO D-SNP). Emergency Services have a $125 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have a $0 copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay. Chiropractic Services are covered with a $20 copay, while Routine Chiropractic Care is not covered. Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $30 copay. Mental Health Specialty Services have a $30 copay for both individual and group sessions. Podiatry Services may have a copay between $0 and $30, including routine foot care with no copay. Other Health Care Professional services have a copay between $0 and $20. Psychiatric Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education, and other preventive services are covered, with no copay for specific services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for a hearing aid with no copay. Prescription hearing aids are covered up to $3,000 per year with no copay, while OTC hearing aids are covered with no copay up to $300 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with a $0 copay and a combined maximum benefit of $200 per year. Eyeglass frames, lenses, and contact lenses are covered with no copay, while upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. There is no copay for covered services and a maximum plan benefit of $2,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. 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 by the Anthem Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with no copay and a 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $30, and lab services with no copay. Diagnostic radiological services have a copay of at most $170 with a minimum copay of $25, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-Ray services have a copay of $25.
Home Health Services See details
Home Health Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan, but the specific services listed are not covered. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Dual Advantage (HMO D-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Anthem Dual Advantage (HMO D-SNP) plan, acupuncture, Dual Eligible SNPs, 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. Over-the-counter items and meal benefits are covered with no copay. Other services like Medicare Community Resource Support are covered with no copay.
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