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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 2026, 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 2026 to people living in Select Counties in California. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $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 $615.00 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:
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Drug Coverage
The Anthem Full Dual Advantage Aligned (HMO D-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, members enjoy no copay for Tier 1 preferred generic drugs through standard pharmacies and standard mail delivery. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance after meeting your deductible. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy, also known as LIS or Extra Help, will pay $0.00 for their Part D premium.
Additional Benefits
The Anthem Full Dual Advantage Aligned (HMO D-SNP) offers comprehensive healthcare coverage with many services available at little to no cost. Major medical services, including outpatient care, primary care visits, specialist consultations, and diagnostic tests, generally feature no copay and a 20% coinsurance. Additionally, members can access emergency services for a $115 copay, urgent care for a $40 copay, and home health services with no copay and no coinsurance. This plan also provides robust supplemental benefits to support daily wellness, including no copay and no coinsurance for routine dental care up to a $3,000 annual limit. Members also benefit from a $450 annual eyewear allowance and up to 96 free one-way transportation trips per year to plan-approved locations. Furthermore, the plan covers select hearing aids and over-the-counter items with no copay and no coinsurance to ensure affordable, comprehensive care.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), with cost-sharing based on Original Medicare-defined copays and coinsurance. Prior authorization is required, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays for acute or psychiatric care.
Outpatient Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, and substance abuse services, with a 20% coinsurance and no copay. Outpatient blood services are covered with no copay and no coinsurance, though prior authorization and doctor referrals are required for most of these benefits.
Partial Hospitalization See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage Aligned (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 with no copay and no coinsurance for up to 96 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Full Dual Advantage Aligned (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 copay and no coinsurance.
Primary Care See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers primary care, specialist, and therapy services with a 20% coinsurance and no copay, though chiropractic services are only partially covered as routine chiropractic care is not covered. Telehealth services are offered with no copay and no coinsurance, while podiatry services require a 20% coinsurance for routine care and no copay for Medicare-covered visits.
Preventive Services See details
Preventive services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), featuring no copay for annual physicals, fitness benefits, and home safety devices, though services like health education and weight management are not covered. Kidney disease education and screenings for glaucoma and diabetes require a doctor referral and have a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), with no copay or coinsurance for fittings, OTC hearing aids up to $300 annually, and select prescription hearing aids up to $3,000 annually. Routine hearing exams require up to 20% coinsurance with no copay, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers vision services, as upgrades are not covered. Routine eye exams and contact lenses are covered with no copay and a 20% coinsurance, while eyeglasses are covered with no copay and no coinsurance under a combined $450 annual eyewear limit.
Dental Services See details
Dental services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), which offers a $3,000 annual maximum for non-Medicare dental care. Covered preventive and comprehensive services require no copay and no coinsurance, while Medicare-covered dental services have a 20% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers Home Infusion bundled Services under prior authorization, as Part D home infusion drugs are not covered as part of the bundled service. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan with 20% coinsurance and no copay. This benefit ensures you have affordable access to critical kidney dialysis treatments with clear, predictable costs.
Medical Equipment See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers medical equipment, including durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Prosthetic devices and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers diagnostic and radiological services, including lab tests, outpatient X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services.
Home Health Services See details
Home Health Services are covered by Anthem Full Dual Advantage Aligned (HMO D-SNP) with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan. This includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), requiring prior authorization but allowing admission without a 3-day prior hospital stay. Medicare-defined cost sharing, including coinsurance and copayments, applies to covered days, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Anthem Full Dual Advantage Aligned (HMO D-SNP), providing acupuncture, over-the-counter items, chronic illness meal benefits, and community resource support with no copay and no coinsurance. Highly Integrated Services for Dual Eligible SNPs are not covered under this benefit.
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