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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 Alameda 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 $6.40. 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 you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), the monthly premium is $6.40.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services have no copay, including primary care visits, routine eye exams, hearing aid fittings, prescription hearing aids, and many dental services. Other services such as outpatient services, ambulance services, and some specialist visits have a coinsurance of 20%. Emergency services have a copay of $90, while urgently needed services have a $45 copay. The plan also covers services like home health, home infusion, and medical equipment, with specific cost-sharing details outlined in the plan's benefits. There are also additional benefits like meal benefits, over-the-counter items, and acupuncture, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the cost sharing is defined by Original Medicare and additional days, upgrades, and non-Medicare-covered stays are not covered. Prior authorization is required for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered under the Anthem Dual Advantage (HMO D-SNP) plan. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse services have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (HMO D-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay. 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, while 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. Chiropractic services require a referral and prior authorization, and have a 20% coinsurance for routine care, with a $0 copay for routine care. Occupational Therapy Services have a 20% coinsurance. Physician specialist services, additional telehealth benefits, and other healthcare professionals have no copay. Mental health specialty services, including individual and group sessions, have a 20% coinsurance. Podiatry services including routine foot care have a 20% coinsurance. Psychiatric services, including individual and group sessions, have a 20% coinsurance. Physical therapy and speech-language pathology services have a 20% coinsurance. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services including Fitness Benefit, Personal Emergency Response System (PERS), Remote Access Technologies, and Home and Bathroom Safety Devices with varying copays. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 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 a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay and up to $3,000 per year, while OTC hearing aids are covered with no copay up to $300 per year; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, while 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 include coverage for Medicare dental services with 20% coinsurance, and other dental services with a maximum benefit of $1400 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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 under the Anthem Dual Advantage (HMO D-SNP) plan 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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. Members pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts 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 under Anthem Dual Advantage (HMO D-SNP). Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, with no copay for any of the 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, but Additional Hours of Care and Personal Care Services are not covered. A referral and authorization are required for this benefit.
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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Dual Advantage (HMO D-SNP) plan, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
Other Services include acupuncture, over-the-counter items, meal benefits, and Medicare Community Resource Support. Acupuncture has no copay, while over-the-counter items and meal benefits also have no copay. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many more are not covered.
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