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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 Greater Denver Area. This plan received an overall rating of 3 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 $16.00. 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 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:
Sign up for Anthem Dual Advantage (HMO D-SNP)
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Drug Coverage
The Anthem Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your Part D premium will be $16.00 per month. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers a range of benefits beyond Original Medicare, with varying cost-sharing structures. Many services have no copay, including primary care visits, hearing exams, prescription hearing aids, OTC hearing aids, routine eye exams, and many dental services. The plan covers services such as inpatient and outpatient hospital care, ambulance services, emergency services, and home health services, but often involves coinsurance, which can range from 0% to 20% depending on the service. Other benefits include hearing, vision, and dental services, as well as coverage for medical equipment, diagnostic services, and home infusion.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Additional Days, Non-Medicare-covered Stays, and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric are not covered. Both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric require prior authorization and have coinsurance costs as defined by Original Medicare.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of at least 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (HMO D-SNP) plan, with a $55 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services with no copay for plan-approved health-related locations, with 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Dual Advantage (HMO D-SNP) plan covers primary care physician services with no copay, and chiropractic services with 20% coinsurance. Occupational therapy services, mental health specialty services, psychiatric services, physical therapy, and speech-language pathology services are covered with 20% coinsurance. Additional telehealth benefits have no copay, and podiatry services have 20% coinsurance and no copay for Medicare-covered services.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Other preventive services, like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, have a 20% coinsurance. 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of 20% for routine hearing exams and fitting/evaluation for hearing aids, with no copay, while prescription hearing aids have no copay and a maximum benefit of $3,000 every year, and OTC hearing aids have no copay and a maximum benefit of $300 every year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams have no copay. Eyewear has a 20% coinsurance, and a combined maximum benefit of $500. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $4,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered with no copay. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan, 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 Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Anthem Dual Advantage (HMO D-SNP) plan covers Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Medical supplies and prosthetic devices have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
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. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services are not covered. Prior authorization is required, and there is coinsurance for some services, but the specific cost-sharing details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and coinsurance applies.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Other 1, both with no copay. However, acupuncture, meal benefits, 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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