A non-government entity
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 2026, 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 Ventura county. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $105.00 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 $9250.00 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:
Sign up for Anthem Dual Advantage (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Dual Advantage (HMO D-SNP) Medicare plan features an Enhanced Alternative drug benefit with a $105 annual prescription drug deductible. Individuals who qualify for the low-income subsidy can benefit from a reduced Part D premium of zero dollars. Under this plan, Tier 1 preferred generic drugs have no copay at standard pharmacies and through standard mail delivery. For other tiers, you will pay a 25% coinsurance for Tier 2 standard generics and Tier 3 preferred brands, and a 31% coinsurance for Tier 4 non-preferred drugs. These initial coverage rates apply until your total costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) offers robust medical coverage with no copays for many primary care, specialist, and outpatient hospital services, though a 20% coinsurance typically applies. Inpatient hospital stays feature no copay with Medicare-defined coinsurance, while home health care and routine preventive services are available with no copay or coinsurance. For urgent needs, members pay a $40 copay for urgent care and a $115 copay for emergency services, which is waived if hospitalized within 24 hours. Supplemental benefits further enhance this plan by covering routine dental, vision, and hearing services with minimal out-of-pocket expenses. Dental care is covered up to $1,000 annually with no copay or coinsurance for preventive services, and eyewear and hearing aids are covered up to generous annual limits with no copay. Additionally, the plan provides up to 48 free one-way trips per year to approved locations and covers over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital acute and psychiatric services are partially covered by Anthem Dual Advantage (HMO D-SNP) with no copay and Medicare-defined coinsurance, subject to prior authorization. However, additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services with no copay and a 20% coinsurance. Outpatient blood services are also covered with no copay and no coinsurance, though prior authorization or referrals may be required for certain services.
Partial Hospitalization See details
Anthem Dual Advantage (HMO D-SNP) covers partial hospitalization benefits with a $60 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Anthem Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with no copays or coinsurance.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) covers primary care, specialist, and mental health services with a 20% coinsurance and no copay. Chiropractic services are partially covered, as routine chiropractic care is not covered, while telehealth benefits and Medicare-covered podiatry services are available with no copay.
Preventive Services See details
Anthem Dual Advantage (HMO D-SNP) offers partially covered preventive services, excluding health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling. Covered benefits like annual physicals, fitness programs, and personal emergency response systems feature no copay and no coinsurance, while other preventive services require a 20% coinsurance and no copay.
Hearing Services See details
Anthem Dual Advantage (HMO D-SNP) covers routine hearing exams and fittings with no copay and up to 20% coinsurance. Prescription hearing aids are partially covered up to a $3,000 annual limit with no copay or coinsurance, but inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Dual Advantage (HMO D-SNP) features no deductibles for vision services, covering one routine eye exam per year with no copay and a 20% coinsurance. Eyewear is partially covered up to a $325 annual limit with no copay for eyeglasses, frames, lenses, and contact lenses, and a 20% coinsurance on contact lenses, while upgrades are not covered.
Dental Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers dental services up to a $1,000 annual limit, excluding maxillofacial prosthetics, implant services, and orthodontics. Covered preventive and comprehensive dental services have no copay or coinsurance, while Medicare-covered dental services require a 20% coinsurance and no copay.
Home Infusion bundled Services See details
Anthem Dual Advantage (HMO D-SNP) covers home infusion bundled services with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin drugs. Other covered Medicare Part B drugs, including chemotherapy and radiation drugs, have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Anthem Dual Advantage (HMO D-SNP) with a 20% coinsurance and no copay.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers diabetic supplies and therapeutic shoes with no copay and no coinsurance. Durable medical equipment, prosthetics, and medical supplies are covered with no copay and require prior authorization, carrying a coinsurance of 0% to 20% depending on the item.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance. This coverage includes diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays, all of which require prior authorization and a doctor referral.
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. Prior authorization and a doctor referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Dual Advantage (HMO D-SNP) plan. Consequently, there is no coverage, copay, or coinsurance for any associated sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services, which require prior authorization, a Medicare-defined coinsurance, and no copay. Under this plan, additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers other services, providing over-the-counter items, meal benefits, and Medicare community resource support with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved