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Anthem Dual Advantage 2 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Dual Advantage 2 (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 2 (PPO D-SNP) in 2025, please refer to our full plan details page.
Anthem Dual Advantage 2 (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. The overall rating for this plan is not yet available for 2025.
It's important to know that Anthem Dual Advantage 2 (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 2 (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 2 (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 2 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.60. 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 combined Maximum Out-Of-Pocket cost of $14000.00 (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 $14000.00 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:
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Drug Coverage
The Anthem Dual Advantage 2 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra help".
Additional Benefits
The Anthem Dual Advantage 2 (PPO D-SNP) plan offers a variety of health benefits, including inpatient hospital stays with a copay for the first week and no copay thereafter. Outpatient services and ambulance services have coinsurance requirements, while emergency services have copays. Preventive services, primary care, and home health services are covered with no copay, and the plan also provides coverage for hearing, vision, and dental services, as well as medical equipment. This plan provides additional benefits such as hearing exams, routine eye exams, and oral exams with no copay. The plan also covers services such as home infusion, dialysis, and diagnostic services with coinsurance. However, the plan does not cover cardiac rehabilitation services, and some other services have limited coverage or are not covered at all.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $275 for days 1-7, and no copay for days 8-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, require prior authorization and have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of at least 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage 2 (PPO D-SNP) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay and 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The Anthem Dual Advantage 2 (PPO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a 20% coinsurance for routine care, and occupational therapy services have a 20% coinsurance.
Preventive Services See details
The Anthem Dual Advantage 2 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, with no copay for Fitness Benefit, Personal Emergency Response System, and Remote Access Technologies, but other services may have a copay. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services with the Anthem Dual Advantage 2 (PPO D-SNP) plan include hearing exams with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and OTC hearing aids are covered with no copay. However, prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, but upgrades are not covered.
Dental Services See details
Dental Services are covered by the Anthem Dual Advantage 2 (PPO D-SNP), with 20% coinsurance for Medicare Dental Services. Oral exams and teeth cleanings are covered with no copay, but dental X-rays, fluoride treatments, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Dual Advantage 2 (PPO D-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The Anthem Dual Advantage 2 (PPO D-SNP) plan covers medical equipment, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance. Prosthetics and medical supplies are covered with no copay and 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 Dual Advantage 2 (PPO D-SNP) plan. Diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, with a minimum coinsurance of 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Anthem Dual Advantage 2 (PPO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Dual Advantage 2 (PPO D-SNP) plan. Specifically, 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Dual Advantage 2 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are partially covered under the Anthem Dual Advantage 2 (PPO D-SNP) plan, with Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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 not covered. Medicare Community Resource Support has no copay.
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