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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 2026, 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 Greater Denver Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $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 $615.00 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 $9250.00 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) prescription drug plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using standard pharmacies or standard mail order services. For higher-tier medications, including Tier 3 preferred brand and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for one, two, or three-month supplies. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply through standard pharmacies and mail order.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and home health services. Outpatient care, diagnostic services, and dialysis are also accessible with no copay, though they carry a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while urgently needed services require a $40 copay. For supplemental care, the plan features no copay and no coinsurance for preventive and comprehensive dental services up to a $4,000 annual maximum. Routine vision exams and hearing fitting evaluations are also covered with no copay, while prescription hearing aids and over-the-counter items are available with no copay and no coinsurance up to set annual limits. Additionally, members can utilize up to 24 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services with no copay and a 20% coinsurance. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Anthem Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Anthem Dual Advantage (HMO D-SNP) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 lifetime maximum with no copays and no coinsurance.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) offers primary care, specialist visits, telehealth, and other health professional services with no copay and no coinsurance. Therapy services, psychiatric care, and opioid treatment are covered with no copay and 20% coinsurance, while chiropractic services are partially covered, with routine chiropractic care and other chiropractic services not covered.
Preventive Services See details
Preventive services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness and home safety devices. However, several additional services such as health education and nutritional therapy are not covered, and certain screenings and EKGs require a 20% coinsurance with no copay.
Hearing Services See details
Anthem Dual Advantage (HMO D-SNP) covers hearing services with no deductible, offering one annual routine exam with a 20% coinsurance and no copay, alongside fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $3,000 annual limit—excluding inner ear, outer ear, and over-the-ear models—while OTC hearing aids are covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Anthem Dual Advantage (HMO D-SNP) vision services are partially covered with no deductibles, offering one annual routine eye exam and eyewear with no copays, though routine exams and contact lenses require a 20% coinsurance. Upgrades and other eye exam services are not covered, and there is a combined maximum eyewear benefit of $525 per year.
Dental Services See details
Anthem Dual Advantage (HMO D-SNP) dental services are partially covered, excluding implant services and orthodontics which are not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental benefits feature no copay and no coinsurance up to a $4,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay, although prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Anthem Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers medical equipment with no copays, though coinsurance and prior authorization requirements vary by item. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies and therapeutic shoes are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Anthem Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. Covered benefits include diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Anthem Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Dual Advantage (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, although prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan does not cover additional days beyond the standard Medicare-covered limit, it does allow for admission without requiring a prior three-day inpatient hospital stay.
Other Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated services are not covered.
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