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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 2025, 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 2025.
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 $30.70. 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 $590.00 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 $9350.00 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 (HMO D-SNP) plan has a defined standard for drug coverage. The plan includes a deductible of $590.00. If you qualify for the low-income subsidy, you'll pay $30.70. After the deductible, you'll pay costs for drugs in each tier until your total drug costs reach $2000.00, at which point you will enter the next coverage phase.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a variety of health benefits with varying costs. Many services have no copay, including routine eye exams, fitting/evaluation for hearing aids, transportation services, additional telehealth benefits, and OTC items. Other services, such as emergency services, partial hospitalization, and home infusion bundled services, have copays ranging from $35 to $110. Many services are subject to coinsurance, with rates typically at 20% for services like outpatient hospital, primary care, and dental services. The plan also covers hearing aids with no copay up to a maximum amount, and provides coverage for vision services and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but specific services like Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For covered services, you may be responsible for coinsurance, as defined by Medicare.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services have no copay. Ambulatory surgical center services and outpatient substance abuse services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. This benefit requires prior authorization and has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, there is a $110 copay with no coinsurance, and for Urgently Needed Services, there is a $45 copay with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay and no coinsurance.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy and speech-language pathology services, and chiropractic services have a 20% coinsurance, while additional telehealth benefits have no copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a 20% coinsurance. Podiatry services have a 20% coinsurance and no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. Additional preventive services may have a copay, and other services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay up to a maximum of $3,000 every year, while OTC hearing aids are covered with no copay up to a maximum of $300 every year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Routine eye exams have no copay, and eyewear has a 20% coinsurance with a combined maximum benefit of $425 per year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with 20% coinsurance. Other dental services have a maximum benefit of $4,000 per year, and covered services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with 0-20% coinsurance and no copay. Prosthetic devices and medical supplies are covered with 20% coinsurance, and diabetic equipment is covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and you will pay the Medicare-defined cost share, with coinsurance information available in the plan details.
Other Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers acupuncture, over-the-counter (OTC) items, meal benefits, and other services. Acupuncture has no copay and is limited to 12 treatments per year, while OTC items and meal benefits also have no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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