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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 San Francisco 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 $6.60. 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 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. If you qualify for the low-income subsidy, the plan's premium may be reduced. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs, though you may still pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, such as primary care visits, preventive services like annual physical exams, and certain vision and dental services, are available with no copay. You'll also find no copay for services like home health and ambulance/transportation services. The plan also includes coinsurance for some services, such as outpatient and emergency services, hearing and vision exams, and some mental health and therapy services. Additional benefits include coverage for hearing aids, eyewear, and a yearly allowance for dental services. However, some services like cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, though additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered. You will be charged the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse, and ASC services have a minimum 20% coinsurance and a maximum 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, 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, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including 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
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with 20% coinsurance, but routine care is not covered. Occupational Therapy Services have a 20% coinsurance, and require prior authorization and a doctor referral. Physician Specialist Services are covered with no copay. Mental Health Specialty Services are covered with 20% coinsurance for individual and group sessions. Podiatry Services are covered with 20% coinsurance for routine foot care, and no copay for Medicare-covered services. Other Health Care Professional services are covered with no copay. Psychiatric Services are covered with 20% coinsurance for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with 20% coinsurance, and require prior authorization and a doctor referral. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services are covered with 20% coinsurance and require prior authorization and a doctor referral.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services with a copay, including Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices. Other services like Health Education, In-Home Safety Assessment, and others are not covered. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay, but routine hearing exams have a 20% coinsurance. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay, up to a maximum of $300 per year.
Vision Services See details
Under the Anthem Dual Advantage (HMO D-SNP) plan, vision services include eye exams and eyewear coverage. Eye exams have a 20% coinsurance, and routine eye exams have no copay, while eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while upgrades are not covered, and there is a combined maximum of $350 per year for eyewear.
Dental Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services up to a maximum of $1500 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 by the Anthem Dual Advantage (HMO D-SNP) plan. 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 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 no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. All diagnostic services and radiological services have no copay, and a coinsurance of at most 20% applies to 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 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 Dual Advantage (HMO D-SNP) plan. Prior authorization is required for these services if they were covered, but they are not.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the cost sharing details are not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers acupuncture with no copay, over-the-counter items with no copay, and a meal benefit with no copay. Other services include Medicare Community Resource Support with no copay. However, 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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