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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) prescription drug plan features a $615.00 annual deductible. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail delivery. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance during the initial coverage phase. If you qualify for the low-income subsidy, also known as Extra Help, your Part D premium and costs may be reduced to $0.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs.
Additional Benefits
The Anthem Full Dual Advantage Aligned (HMO D-SNP) plan offers comprehensive medical coverage where most core services, including doctor visits, outpatient care, and diagnostic services, require a 20% coinsurance and no copay. Inpatient hospital stays and skilled nursing facility care charge Medicare-defined coinsurance with no copay, while emergency room visits carry a $115 copay. Additionally, home health care, diabetic supplies, and up to 96 one-way transportation trips per year are provided with no copay and no coinsurance. This plan also features valuable supplemental benefits to help reduce out-of-pocket costs for routine care. Dental services and prescription hearing aids are covered up to a $3,000 annual limit each with no copay and no coinsurance. Members also benefit from a $425 annual eyewear allowance, alongside coverage for acupuncture, meals, and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays, which require prior authorization and charge Original Medicare-defined coinsurance with no copays. Additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services with a 20% coinsurance and no copay. Outpatient blood services are covered with no copay and no coinsurance, with most outpatient services requiring prior authorization and a doctor referral.
Partial Hospitalization See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to receive these 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. Transportation services are partially covered with no copay and no coinsurance for up to 96 one-way trips per year to plan-approved locations, though 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, and urgently needed services with a $40 copay and no coinsurance. Additionally, worldwide emergency, urgent, and transportation services are covered with no copay up to a $100,000 maximum limit.
Primary Care See details
Primary care benefits are covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), with most doctor visits, specialist consultations, and therapy services requiring a 20% coinsurance and no copay. Additional telehealth and Medicare-covered podiatry services are offered with no copay, though chiropractic services are only partially covered as routine chiropractic care is not covered.
Preventive Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers preventive services, offering no copay for annual physical exams, zero-dollar preventive services, and select supplemental benefits like fitness and PERS. A 20% coinsurance applies to kidney disease education and other preventive screenings, while several sub-services like health education and weight management programs are not covered.
Hearing Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers hearing services with no deductibles, including routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to a $3,000 annual limit with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered, while OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers vision services, including one routine eye exam per year with no copay and a 20% coinsurance. The plan also provides a combined annual limit of $425 for eyewear with no copay, which includes contact lenses (subject to a 20% coinsurance) and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) offers partial coverage for dental services, including a $3,000 yearly maximum for preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers home infusion bundled services with prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers Dialysis Services with a 20% coinsurance and no copay.
Medical Equipment See details
Medical Equipment is covered by Anthem Full Dual Advantage Aligned (HMO D-SNP) with no copays for all services, though durable medical equipment carries 0% to 20% coinsurance and prosthetics and medical supplies require 20% coinsurance. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Full Dual Advantage Aligned (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services, which include lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays.
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, though prior authorization and a doctor referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) plan, meaning there is no copay or coinsurance because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and Medicare-defined coinsurance, requiring prior authorization but no preceding three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), featuring acupuncture, over-the-counter items, meal benefits, and community resource support with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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