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Anthem Dual Advantage (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Dual Advantage (PPO 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 (PPO D-SNP) in 2026, please refer to our full plan details page.
Anthem Dual Advantage (PPO D-SNP) is a PPO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in CA. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Anthem Dual Advantage (PPO 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 (PPO 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 (PPO 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 (PPO 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Dual Advantage (PPO D-SNP)
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Drug Coverage
The Anthem Dual Advantage (PPO D-SNP) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, members pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs when using standard retail or standard mail-order pharmacies. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for Medicare Part D covered drugs. Additionally, those who qualify for the low-income subsidy, or Extra Help, may see their Part D premium reduced to $12.00.
Additional Benefits
The Anthem Dual Advantage (PPO D-SNP) plan offers comprehensive medical coverage with predictable cost-sharing, including no copays for primary care visits, telehealth, and home health services, though outpatient care generally requires a 20% coinsurance. Inpatient hospital stays require a $275 daily copay for the first five days and no copay for days six through 90. Emergency room visits require a $90 copay, which is waived if you are admitted, while urgently needed services carry a $40 copay. Supplemental benefits under this plan include routine dental, vision, and hearing services, which feature no copays for routine exams but are subject to annual coverage limits and a 20% coinsurance for certain services. Members also benefit from no copays for up to 12 one-way transportation trips per year to plan-approved locations and an allowance for over-the-counter items. Skilled nursing facility stays require no copay for the first 20 days, followed by a $196 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem Dual Advantage (PPO D-SNP) partially covers inpatient hospital acute and psychiatric services, which require a $275 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Dual Advantage (PPO D-SNP) covers outpatient services, with outpatient hospital, observation, ambulatory surgical center, and substance abuse services requiring a 20% coinsurance and no copay. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Dual Advantage (PPO D-SNP) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Dual Advantage (PPO D-SNP) covers ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered under the plan, offering no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Anthem Dual Advantage (PPO D-SNP) for a $90 copay and no coinsurance, with the copay 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 with no copay and no coinsurance.
Primary Care See details
Anthem Dual Advantage (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with a 20% coinsurance and no copay, while telehealth benefits are offered with no copay. Podiatry services feature a 20% coinsurance for routine care and no copay for Medicare-covered services, but chiropractic benefits are only partially covered since routine chiropractic care is not covered.
Preventive Services See details
Anthem Dual Advantage (PPO D-SNP) partially covers preventive services with no copay for annual physicals, PERS, fitness benefits, remote access, and kidney disease education, alongside a 20% coinsurance for glaucoma screenings, diabetes training, rectal exams, and EKGs. Non-covered sub-services include health education, in-home safety, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Anthem Dual Advantage (PPO D-SNP) covers hearing services, including routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance, up to a $59 annual limit. Prescription and OTC hearing aids are also covered with no copay and no coinsurance up to annual limits of $3,000 and $300 respectively, though prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Anthem Dual Advantage (PPO D-SNP) partially covers vision services, offering routine eye exams with no copay, a 20% coinsurance, and no deductible up to a $69 annual limit. Covered eyewear—including contact lenses with a 20% coinsurance and eyeglasses with no coinsurance—features no copay up to a $50 annual limit, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Dual Advantage (PPO D-SNP), requiring a 20% coinsurance and no copay for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $1,200 annual limit. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Dual Advantage (PPO D-SNP) with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin. Medicare Part B chemotherapy, radiation, and other Part B drugs are also covered under this benefit with no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Anthem Dual Advantage (PPO D-SNP) covers dialysis services with a 20% coinsurance and no copay.
Medical Equipment See details
Anthem Dual Advantage (PPO D-SNP) covers medical equipment, offering durable medical equipment (DME) with no copay and no coinsurance to 20% coinsurance. Prosthetics and medical supplies are covered with no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Dual Advantage (PPO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copay and up to 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered by Anthem Dual Advantage (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Dual Advantage (PPO D-SNP) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. Stays require prior authorization and feature no copay or coinsurance for days 1 through 20, followed by a $196 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by Anthem Dual Advantage (PPO D-SNP), offering no copay and no coinsurance for covered benefits like Medicare Community Resource Support, meal benefits, and over-the-counter items up to $38 every three months. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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