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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 $12.00. 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
Anthem Full Dual Advantage Aligned (HMO D-SNP) offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. During the initial coverage phase, you will pay no copay for Tier 1 preferred generic and Tier 5 specialty drugs at standard pharmacies and through standard mail. For Tier 2 standard generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance. If you qualify for the low-income subsidy, your Part D cost is reduced to $12.00. After 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.
Additional Benefits
The Anthem Full Dual Advantage Aligned (HMO D-SNP) offers comprehensive medical coverage, with many essential services featuring no copay. For inpatient hospital stays, skilled nursing, and primary care doctor visits, members pay no copay but are responsible for Medicare-defined or 20% coinsurance. Similarly, outpatient hospital care, diagnostic tests, and dialysis require a 20% coinsurance with no copay, while home health services require no copay and no coinsurance. This plan provides strong supplemental benefits, including dental, vision, and hearing care with no copay and generous annual coverage limits. Members also receive fitness benefits, over-the-counter items, and up to 24 one-way transportation trips per year with no copay and no coinsurance. While many benefits have no copay, emergency services require a $115 copay, and several covered services require prior authorization.
Inpatient Hospital See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers inpatient hospital services, requiring prior authorization and Original Medicare-defined coinsurance with no copay for acute and psychiatric stays. 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 services, including outpatient hospital, observation, ambulatory surgical center, and substance abuse services, which require prior authorization and carry a 20% coinsurance with no copay. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers partial hospitalization benefits with a $60.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Plan-approved transportation is covered for up to 24 one-way trips per year with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Anthem Full Dual Advantage Aligned (HMO D-SNP) 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 benefits with a 20% coinsurance and no copay for most services, including doctor visits, therapy, and psychiatric care. Telehealth and Medicare-covered podiatry sessions are offered with no copay, while chiropractic services are only partially covered because routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Anthem Full Dual Advantage Aligned (HMO D-SNP), offering annual physicals, fitness benefits, and personal emergency response systems with no copays or coinsurance, but requiring a 20% coinsurance and no copay for kidney disease education and other preventive screenings. Uncovered services include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling services.
Hearing Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, excluding inner ear, outer ear, and over-the-ear types. OTC hearing aids are also covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers one routine eye exam per year with no copay and a 20% coinsurance. Eyewear benefits are partially covered with a $150 annual limit, offering contact lenses, eyeglasses, lenses, and frames with no copay (contact lenses require a 20% coinsurance), while eyewear upgrades are not covered.
Dental Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with a 20% coinsurance and no copay. Other preventive and comprehensive dental services are covered up to a $1,400 annual maximum with no copay and no coinsurance, but 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, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and general drugs have no copay, with coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Full Dual Advantage Aligned (HMO D-SNP) with 20% coinsurance and no copay.
Medical Equipment See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though vendor and manufacturer restrictions may apply.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered 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. Prior authorization is 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 non-coverage applies to all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for 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 and charging a Medicare-defined coinsurance with no copay. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Full Dual Advantage Aligned (HMO D-SNP) partially covers other services with no copay and no coinsurance for over-the-counter items, meal benefits, and Medicare community resource support. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
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