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Anthem Full Dual Advantage Aligned (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full Dual Advantage Aligned (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 Aligned (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem Full Dual Advantage Aligned (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in CA. The overall rating for this plan is not yet available for 2025.
It's important to know that Anthem Full Dual Advantage Aligned (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 Aligned (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 Aligned (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 Aligned (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.50. 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 Aligned (HMO D-SNP) plan has a prescription drug deductible of $590. Once you meet your deductible, you will pay the costs for your drugs based on the specific tier and pharmacy you use, until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $25.50 for Part D.
Additional Benefits
The Anthem Full Dual Advantage Aligned (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient and outpatient services, including blood services, have coinsurance requirements. The plan also covers emergency services with copays, while transportation to health-related locations is available with no copay. Preventive services, like annual physical exams, have no copay, while hearing and vision services have coinsurance requirements. Dental services also have coinsurance, with a maximum yearly benefit. The plan provides coverage for home health services with no copay, and other services, like acupuncture and over-the-counter items, are covered with no copay.
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. The coinsurance for covered services is the same as Original Medicare.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services are covered with a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, and are limited to 96 one-way trips per year using rideshare services, bus/subway, van, or medical transport; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan, with a $90 copay. Urgently Needed Services are also covered with a $45 copay, and Worldwide Emergency Services are covered with a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Full Dual Advantage Aligned (HMO D-SNP) plan covers Primary Care Physician Services, 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, Additional Telehealth Benefits, and Opioid Treatment Program Services. For Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, the coinsurance is 20%. For Occupational Therapy Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services, the coinsurance is 20%. Podiatry Services have a 20% coinsurance and no copay. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have copays depending on the service. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, with a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other dental services include oral exams, dental x-rays, and other diagnostic dental services with no copay, as well as a $4,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 Full Dual Advantage Aligned (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered services, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. 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 Aligned (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic, Therapeutic, and Outpatient X-Ray Services have a coinsurance of at most 20% as well.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan, but prior authorization is required. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Anthem Full Dual Advantage Aligned (HMO D-SNP) plan covers acupuncture with no copay and over-the-counter items with no copay, but a maximum benefit coverage amount of $0. The plan also offers a meal benefit with no copay, and other services with no copay. However, services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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