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Anthem Full Dual Advantage (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full Dual Advantage (PPO 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 (PPO D-SNP) in 2025, please refer to our full plan details page.
Anthem Full Dual Advantage (PPO D-SNP) is a PPO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in GA. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Anthem Full Dual Advantage (PPO 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 (PPO 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 (PPO 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 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $40 for Part D drugs. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (PPO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay for days 6-90, while outpatient services, primary care, and preventive services have a coinsurance for some services. The plan also includes no copay for many services, such as ambulance transportation, emergency services, hearing exams, and home health services. Additionally, the plan covers services like dental, vision, and home infusion with specific cost-sharing arrangements, and also provides benefits like OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $305 for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric care are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, with a 20% coinsurance for Outpatient Hospital Services and Observation Services. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of at least 20% for some services, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Full Dual Advantage (PPO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare, are covered by the Anthem Full Dual Advantage (PPO D-SNP) plan. Ground and Air Ambulance services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location have no copay, and include up to 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Anthem Full Dual Advantage (PPO D-SNP) plan covers primary care, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, and opioid treatment program services have a 20% coinsurance. Podiatry services have a 20% coinsurance, and there is no copay for Medicare-covered podiatry services. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional services such as Personal Emergency Response Systems and Fitness Benefits with no copay. Other preventive services like Glaucoma Screenings, Diabetes Self-Management Training, and others have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids and OTC hearing aids have a maximum benefit of $3,000 and $300 respectively, with no copay.
Vision Services See details
The Anthem Full Dual Advantage (PPO D-SNP) plan covers vision services including routine eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance; contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Upgrades are not covered.
Dental Services See details
The Anthem Full Dual Advantage (PPO D-SNP) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Medicare Dental Services have a 20% coinsurance, and other dental services have a maximum plan benefit of $4,000 per year.
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 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 (PPO D-SNP) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and 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 Full Dual Advantage (PPO D-SNP) plan. Diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services all have a coinsurance of at most 20%, with a minimum coinsurance of 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (PPO D-SNP) plan with no copay and no coinsurance. However, 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 (PPO D-SNP) plan. Although the plan covers some cardiac rehabilitation services, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Full Dual Advantage (PPO D-SNP) plan, but require prior authorization. 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
The Anthem Full Dual Advantage (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, 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, 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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