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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 Kern county. The overall rating for this plan is not yet available for 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 $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 $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 Dual Advantage (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, if you use a standard pharmacy, you will pay a $3.00 copay for preferred generic drugs, or 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services come with no copay, including primary care, preventive services, hearing aid fittings, routine eye exams, and dental exams. This plan also covers outpatient services, with coinsurance applying to certain services, as well as inpatient hospital stays and skilled nursing facilities, which require prior authorization. This plan provides coverage for emergency services, with copays for urgent and emergency care, and includes benefits for hearing, vision, and dental services. Other covered services include home health services, medical equipment, and home infusion.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare covered stays, and upgrades for both are not covered. Prior authorization is required for both, and the cost sharing is the Medicare-defined cost share for tier 1, with no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services with a 20% coinsurance, and outpatient blood services with no copay. Outpatient substance abuse services, including individual and group sessions, are covered with a coinsurance of 20%. Ambulatory Surgical Center (ASC) Services have a coinsurance between 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (HMO D-SNP) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay for up to 60 one-way trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Anthem Dual Advantage (HMO D-SNP) plan covers Primary Care Physician Services with no copay, and covers Chiropractic Services with a 20% coinsurance. Occupational Therapy, Physician Specialist, Mental Health Specialty, Psychiatric, Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Podiatry and Other Health Care Professional services are covered with no copay. Additional Telehealth Benefits are covered with no copay, and Opioid Treatment Program Services are covered with a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, Personal Emergency Response System with no copay, Fitness Benefit with no copay, and services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, which have a 20% coinsurance. Health Education, In-Home Safety Assessment, 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 Benefit, 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.
Hearing Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $3,000 per year with no copay, but some specific types of hearing aids are not covered. Over-the-counter hearing aids are covered with no copay up to $300 per year.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Routine eye exams have no copay and a 20% coinsurance, while eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum benefit of $1500 per year, with no copay for 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Dual Advantage (HMO D-SNP) plan, with prior authorization required. 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 under the Anthem Dual Advantage (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetic Devices, with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers diagnostic and radiological services, but requires prior authorization and a doctor's referral. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%. There is no copay for any of these services.
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 not covered by the Anthem Dual Advantage (HMO D-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required, and coinsurance applies.
Other Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay. The plan also covers a meal benefit with no copay, and offers Medicare Community Resource Support with no copay, though a doctor's referral is required. Other services like acupuncture, 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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