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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 2025, 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 out of 5 stars in 2025.
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 $2.50. 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:
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Drug Coverage
The Anthem Full Dual Advantage (HMO D-SNP) plan has a defined standard for its drug coverage. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $2.50 for your Part D drugs. After you pay the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including routine eye exams, hearing aid fitting and evaluations, and over-the-counter items. You'll pay a 20% coinsurance for services like outpatient hospital services, primary care, vision eyewear, and dental services. This plan covers a variety of services with no copay, including ambulance and transportation services, home health services, and hearing aid fittings. There are copays for some services, such as emergency services and partial hospitalization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered. For covered services, see the plan documents for details on the coinsurance.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Full Dual Advantage (HMO D-SNP) with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Full Dual Advantage (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 52 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, and Urgently Needed Services have a $45 copay, and both have no coinsurance, while Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and also has no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with a 20% coinsurance, while Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with a 20% coinsurance, and routine chiropractic care has no copay. Additional Telehealth Benefits are covered with no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay. Annual physical exams have no copay, and additional preventive services have a copay as described in the plan documents. Other preventive services, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, have a 20% coinsurance. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, telemonitoring services, and counseling services are not covered. The plan also covers personal emergency response systems, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, and kidney disease education services.
Hearing Services See details
Hearing Services include hearing exams with at most 20% coinsurance, fitting/evaluation for hearing aids with no copay, prescription hearing aids with no copay and a maximum plan benefit of $3,000 per year, and OTC hearing aids with no copay and a maximum plan benefit of $300 per year. Routine hearing exams and fitting/evaluations are limited to one visit per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Eyewear has a 20% coinsurance, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other services with a $2,000 annual maximum. 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 all have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with a 0-20% coinsurance, and Other Medicare Part B Drugs with a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. 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 under the Anthem Full Dual Advantage (HMO D-SNP) plan. All diagnostic services and radiological services have no copay, and you pay at most 20% coinsurance for diagnostic procedures, tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
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 you will pay the Medicare-defined cost share for tier 1.
Other Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items and meal benefits are also covered with no copay, however, the over-the-counter benefit has a maximum plan benefit coverage amount of $0. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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