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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 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 Select Counties in Virginia. The overall rating for this plan is not yet available for 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 $605.00 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 Dual Advantage (HMO D-SNP) prescription drug plan has an annual drug deductible of $605. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. This makes everyday maintenance medications highly accessible and affordable. For other medication tiers, including Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for up to a three-month supply. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply at standard pharmacies and mail order.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For outpatient services, primary care, specialist visits, and diagnostic testing, members generally pay no copay alongside a 20% coinsurance. Emergency care is accessible with a $115 copay, while urgently needed services require a $40 copay, both with no coinsurance. This plan also features robust supplemental benefits, including preventive and comprehensive dental care up to a $2,000 annual limit with no copay and no coinsurance. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, alongside allowances for eyewear and hearing aids that carry no copays. Additionally, members can access up to 34 one-way transportation trips per year and select medical equipment with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Anthem Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
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. Transportation services are partially covered with no copay and no coinsurance for up to 34 one-way trips per year to plan-approved locations, but 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, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit with no copay and no coinsurance.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, with most of these services requiring prior authorization. Additional telehealth benefits are available with no copay and no coinsurance, though for chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Anthem Dual Advantage (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams and kidney disease education, though select screenings require a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay, 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/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Anthem Dual Advantage (HMO D-SNP) covers hearing services, including annual routine exams with no copay and 20% coinsurance, 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), and OTC hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers vision services, offering one routine eye exam per year with no copay and 20% coinsurance, while other eye exam services are not covered. Covered eyewear has a $300 annual limit with no copays, featuring no coinsurance for glasses and 20% coinsurance for contact lenses, though upgrades are not covered.
Dental Services See details
Anthem Dual Advantage (HMO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered services, and no copay and no coinsurance for other preventive and comprehensive dental up to a $2,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Anthem Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, though select manufacturer restrictions and prior authorization rules apply.
Diagnostic and Radiological Services See details
Anthem Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Anthem Dual Advantage (HMO D-SNP), as all sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and a three-day prior inpatient hospital stay is not required. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers other services with no copay and no coinsurance, including acupuncture limited to 12 treatments per year with prior authorization, over-the-counter items, select meal benefits, and Medicare Community Resource Support. Highly integrated services for dual-eligible SNPs and other unspecified services are not covered under this benefit.
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