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Anthem Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full 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 Full Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem Full 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 Full 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 Full 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 Full 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 Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.50. 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:
Sign up for Anthem Full Dual Advantage (HMO D-SNP)
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Drug Coverage
The Anthem Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. This zero-dollar coverage applies to one-month, two-month, and three-month supplies. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members are responsible for a 25% coinsurance across all supply durations. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply filled at standard pharmacies or through standard mail order. This plan offers a straightforward cost-sharing structure to help you manage your prescription drug budget.
Additional Benefits
The Anthem Full 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. Many everyday medical needs, including primary care, specialist visits, diagnostic services, and dialysis, are covered with no copay and a 20% coinsurance. Emergency care requires a $115 copay, while urgent care has a $40 copay, both with no coinsurance. This plan also includes key supplemental benefits, such as preventive and comprehensive dental care up to $3,000 annually with no copay and no coinsurance. Additionally, members benefit from no copays on routine vision exams, an annual $425 eyewear allowance, and up to 60 one-way transportation trips per year with no copay or coinsurance. Hearing aids and over-the-counter items are also covered with no copay or coinsurance up to specified annual limits.
Inpatient Hospital See details
Inpatient hospital services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance and prior authorization are required for outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem Full Dual Advantage (HMO D-SNP) plan with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (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 or coinsurance, providing up to 60 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum limit of $100,000.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Chiropractic services are covered, though routine and other chiropractic services are not covered, and routine podiatry is limited to 4 visits per year with a 20% coinsurance and no copay.
Preventive Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers preventive services, offering an annual physical exam and kidney disease education with no copay and no coinsurance, while glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome-visit EKGs require a 20% coinsurance and no copay. Additional preventive benefits are partially covered, providing fitness, remote access, home safety, and personal emergency response systems with no copay and no coinsurance, though health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually, though inner, outer, and over-the-ear types are not covered. OTC hearing aids are also covered with no copay or coinsurance up to a $300 yearly limit.
Vision Services See details
Vision services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no deductible, excluding other eye exams and eyewear upgrades. Covered benefits include one annual routine eye exam with no copay and 20% coinsurance, plus up to $425 yearly for eyewear, which offers eyeglasses with no copay or coinsurance and contact lenses with no copay and 20% coinsurance.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, and other preventive and comprehensive dental services with no copay, no coinsurance, up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Full Dual Advantage (HMO D-SNP) with no copayments, although coinsurance may apply depending on the item. Durable medical equipment and prosthetics require prior authorization and carry up to 20% coinsurance, while diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copayment and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. While some services are covered, specific sub-services including standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. Beneficiaries can be admitted to a participating facility without a prior three-day inpatient hospital stay.
Other Services See details
Anthem Full Dual Advantage (HMO D-SNP) offers partially covered other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year with prior authorization, over-the-counter items, meal benefits, and Medicare Community Resource Support. Highly integrated services for dual-eligible SNPs are not covered under this benefit.
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