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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 Ohio. 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 $28.90. 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 the deductible, you will pay the costs for your drugs, but the specific cost-sharing amounts for each drug tier are not provided in the summary. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you'll pay a reduced monthly premium of $28.90. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have a 20% coinsurance, including outpatient and primary care services, along with some preventive services. Emergency services have a copay, and transportation services are covered with no copay for 156 one-way trips per year. This plan also includes additional benefits such as dental and vision coverage, with no copay for some services, and coverage for hearing aids. Other notable benefits include no copay for home health services, medical equipment, and over-the-counter items, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan, though the specific cost-sharing details are not provided. Additional days for inpatient hospital, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include 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, while ambulatory surgical center services and outpatient substance abuse services also have a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage (HMO D-SNP) plan, and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered, with a 20% coinsurance for both ground and air ambulance services, and no copay. Transportation services to plan-approved health-related locations are covered for 156 one-way trips per year with no copay.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have a $0 copay.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance, and covers chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, and opioid treatment program services, all with a 20% coinsurance. This plan also covers additional telehealth benefits with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, Kidney Disease Education Services, and Other Preventive Services. Other Preventive Services have a 20% coinsurance for Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, 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. Personal Emergency Response System (PERS), Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Fitness Benefit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay, while prescription hearing aids and OTC hearing aids have no copay. The plan covers up to $3,000 annually for prescription hearing aids and $300 annually for OTC hearing aids.
Vision Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Routine eye exams have no copay and a 20% coinsurance, while eyewear has a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay. The plan offers a combined maximum of $400.00 per year for eyewear.
Dental Services See details
Dental services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Medicare Dental Services have a 20% coinsurance, while 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, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require 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 Full Dual Advantage (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
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%, while DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and 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 all services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic, Therapeutic, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) 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, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. You will pay the Medicare-defined cost share for tier 1, with coinsurance details available in the plan documents.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with no copay, and a maximum benefit coverage amount of $175.00 per month. Other services such as 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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