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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 Ohio. 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 $19.30. 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 $4150.00 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 $590.00 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $19.30. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with copays, and partial hospitalization with a copay. Emergency, urgent, and worldwide emergency services are covered with varying copays. The plan covers primary care, specialist visits, and many other services with copays. Preventive services, hearing, vision, and dental services are covered, often with no copay or low copays for specific services. The plan also covers ambulance, transportation, home infusion, dialysis, medical equipment, diagnostic, home health, cardiac rehabilitation, and skilled nursing facility services with varying cost-sharing structures, including copays and coinsurance. Additionally, the plan offers over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
The Anthem Dual Advantage (HMO D-SNP) plan covers inpatient hospital stays, including services not usually covered by Medicare plans, with a $295 copay for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital are covered with no copay, while non-Medicare-covered stays and upgrades are not covered. Inpatient hospital psychiatric stays are covered with the same cost-sharing as inpatient hospital stays, while non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Anthem Dual Advantage (HMO D-SNP) plan, with copays ranging from $0 to $295. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $260 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered with no copay and no coinsurance, for up to 24 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Anthem Dual Advantage (HMO D-SNP). Emergency Services have a $140 copay, and Urgently Needed Services have a $20 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
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, and physician specialist services with a $25 copay. The plan also covers mental health specialty services, podiatry services with a copay between $0 and $25, and other health care professional services with a copay between $0 and $20. Additionally, the plan covers psychiatric services, physical therapy, 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
Preventive Services include no copay for Medicare-covered preventive services and annual physical exams, as well as no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services, Personal Emergency Response Systems, Fitness Benefits, and Remote Access Technologies have no copay. 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, and telemonitoring services are not covered. Home and bathroom safety devices and modifications have no copay.
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 plan-specified maximum benefit of $2000 per year, and OTC hearing aids are covered with no copay up to a maximum 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 between $0 and $25, and eyewear with a $0 copay. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with a $0 copay, but upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,500 annual maximum. There is no copay for 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
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 coverage includes Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a copay of $50.
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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover the specific services. There is a copay for some cardiac and pulmonary rehabilitation services.
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 $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefits, with no copay for either. 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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