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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 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 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 $13.10. 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 $2900.00 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. This means you must pay this amount out-of-pocket before your drug coverage begins. After the deductible, your costs will depend on the specific drug tier and pharmacy you use, but the exact costs are not specified in this summary. Once your total drug costs reach $2000, 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 (LIS), your monthly Part D premium will be $13.10.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes no copays for primary care, preventive services like an annual physical, and many outpatient services. The plan also provides coverage for hospital stays, ambulance services, and mental health services, with varying copays depending on the specific service. Additional benefits include coverage for hearing, vision, and dental services, with copays ranging from $0 to $25 for certain services. Other notable benefits include coverage for home health services with no copay, and a $0 copay for many other services. However, some services, such as certain home modifications and durable medical equipment, may have coinsurance or maximum benefit limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Anthem Dual Advantage (HMO D-SNP) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, you will pay a $245 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services with the Anthem Dual Advantage (HMO D-SNP) plan include coverage for all outpatient hospital services with a copay between $0 and $245, observation services with a $245 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $250 copay, 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 include a $90 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay. Worldwide Emergency Services have a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Dual Advantage (HMO D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. The plan also covers podiatry services with a copay between $0 and $25, other health care professional services with a copay between $0 and $20, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $25 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, like Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Personal Emergency Response System (PERS), are covered, with a $0 copay for PERS and Fitness Benefit, and a maximum plan benefit coverage amount of $500 for Home and Bathroom Safety Devices and Modifications. Other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $2000 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year.
Vision Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with a $0 copay. Eyewear has a combined maximum plan benefit coverage amount of $300 per year.
Dental Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers dental services, including oral exams, X-rays, and other diagnostic and preventive services with no copay, as well as orthodontic services, restorative services, and more with no copay. This plan has a maximum benefit of $3,000 per year for other dental services.
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 required. For Medicare Part B Insulin Drugs, there is a $35 copay, while 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. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Anthem Dual Advantage (HMO D-SNP) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance. 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, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay that can be up to $150, 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 under the Anthem 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 covered under the Anthem Dual Advantage (HMO D-SNP) plan, but the plan does not cover any of the sub-services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Dual Advantage (HMO D-SNP), with no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Anthem Dual Advantage (HMO D-SNP) plan, 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. Over-the-Counter (OTC) Items and Meal Benefits have no copay. Other 1 has no copay.
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