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Anthem I Carelon Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon 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 I Carelon Full Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon 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 County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I Carelon 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 I Carelon 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 I Carelon 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 I Carelon 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 $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 $8850.00 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 I Carelon Full Dual Advantage (HMO D-SNP) plan has a $590 deductible. After the deductible is met, you will pay for your drugs based on the tier and the pharmacy you use. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $6 copay for preferred generic drugs at a standard or mail pharmacy.
Additional Benefits
The Anthem I Carelon Full Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying costs. Many services have no copay, including routine hearing exams, OTC items, and home health services. However, some services come with coinsurance, such as 20% for outpatient services, primary care, vision, and dental services. The plan covers emergency services with a copay, while other services like transportation and hearing aids have specific coverage limits. This plan also provides coverage for specific services with no copay, such as outpatient blood services, and covers a wide range of other services with some cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but the coinsurance details are not specified. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered stays for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, each with a 20% coinsurance. Outpatient Substance Abuse Services, including individual and group sessions, are covered with a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The Anthem I Carelon Full Dual Advantage (HMO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services with no copay. Transportation services to any health-related location are not covered, but the plan covers 52 one-way trips every year to plan-approved health-related locations using rideshares, buses, vans, or medical transport.
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, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Anthem I Carelon Full Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Routine chiropractic care has no copay, while other chiropractic services are subject to a copay. Individual and group mental health and psychiatric sessions have a 20% coinsurance. Podiatry services have a 20% coinsurance, while Medicare-covered podiatry services have no copay. Additional telehealth benefits have no copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services with a copay that varies by service. Other covered services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit, all with 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 at most 20% coinsurance, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a maximum benefit of $3,000 per year with no copay, while OTC hearing aids have a maximum benefit of $300 per year with no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams, with a 20% coinsurance for routine eye exams, and eyewear, with a 20% coinsurance for contact lenses. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Eyewear has a combined maximum plan benefit coverage amount of $200 per year. 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 $2000 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, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have 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 under the Anthem I Carelon Full Dual Advantage (HMO D-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment (DME), with coinsurance between 0% and 20%, and no copay. Prosthetics and medical supplies have a 20% coinsurance, and diabetic equipment is covered with no copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. There is no copay for any of these services. Diagnostic procedures, 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 by the Anthem I Carelon Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. 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 I Carelon Full Dual Advantage (HMO D-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered stays, and non-Medicare-covered stays are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1, with coinsurance details available in the plan documents.
Other Services See details
The Anthem I Carelon 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 (OTC) items and meal benefits are also covered with no copay, and the plan also covers Medicare Community Resource Support with no copay. However, services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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