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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 2026, 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 Clark and Washoe Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $0.00. 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 $200.00 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:
Sign up for Anthem Full Dual Advantage (HMO D-SNP)
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Drug Coverage
The Anthem Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $200. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. For higher-tier medications, Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Additionally, Tier 5 specialty drugs are subject to a 30% coinsurance for a one-month supply.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) offers comprehensive medical coverage with many essential services available at minimal cost. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. For outpatient care, specialist visits, and diagnostic testing, you will generally pay no copay along with a 20% coinsurance, while emergency room visits require a $115 copay. This plan also features valuable supplemental benefits designed to reduce out-of-pocket expenses for everyday healthcare needs. Comprehensive dental care up to $2,250, prescription hearing aids up to $3,000, and eyewear up to $300 are all covered with no copay and no coinsurance. Additionally, members can access up to 52 one-way transportation trips per year and routine acupuncture treatments with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, providing acute and psychiatric care with no copay and no coinsurance, subject to prior authorization. However, additional hospital days, non-Medicare-covered stays, and room upgrades are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, with prior authorization and referrals required for most of these outpatient benefits.
Partial Hospitalization See details
Anthem Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required before receiving this care.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered with no copay or coinsurance for up to 52 one-way trips per year to plan-approved locations. Transportation to any health-related location is not covered.
Emergency Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan limit of $100,000.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Chiropractic services are partially covered, providing up to 20 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physicals, kidney disease education (referral required), and select supplemental benefits, while glaucoma screenings, diabetes training, digital rectal exams, and EKGs require a referral and 20% coinsurance with no copay. However, this benefit is partially covered because health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemo-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) hearing services feature no deductible, offering routine exams and fitting evaluations for no copay, with a 20% coinsurance on routine exams and no coinsurance for evaluations. 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 hearing aids which are not covered, while over-the-counter hearing aids are covered with no copay and no coinsurance up to a $300 annual limit.
Vision Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers vision services with no deductibles, offering one annual routine eye exam and contact lenses with no copay and a 20% coinsurance. Eyeglasses, lenses, and frames are covered with no copay up to a $300 annual limit, while upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, and comprehensive care up to $2,250 annually with no copay or coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Full Dual Advantage (HMO D-SNP) with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization or manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home Health Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers cardiac rehabilitation services with no copay and prior authorization, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partial coverage for other services, offering no copay and no coinsurance for acupuncture (limited to 24 treatments per year), over-the-counter items, chronic illness meals, and community resource support. Highly integrated Dual Eligible SNP services and other miscellaneous benefits are not covered.
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