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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 2026, 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. This plan received an overall rating of 2.5 out of 5 stars in 2026.
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 $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 $200.00 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 2 (PPO D-SNP)
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Drug Coverage
The Anthem Dual Advantage 2 (PPO D-SNP) offers an enhanced alternative drug benefit with an annual prescription drug deductible of $200.00. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic and Tier 5 specialty drugs filled through standard retail or standard mail pharmacies. For other tiers, you will pay a 25% coinsurance for Tier 2 standard generic and Tier 3 preferred brand drugs, and a 30% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy, or Extra Help, can reduce their Part D premium to $0.00.
Additional Benefits
The Anthem Dual Advantage 2 (PPO D-SNP) offers comprehensive medical coverage, featuring no copays for primary care, specialist visits, and outpatient services, which instead carry a standard 20% coinsurance. For inpatient hospital stays, members pay a $275 daily copay for the first 7 days, followed by no copay for days 8 through 90. Emergency care is accessible with a $90 copay, while urgent care requires a $40 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as up to $1,500 annually for preventive and comprehensive dental services with no copay or coinsurance. Members benefit from a $225 annual eyewear allowance, up to $3,000 for prescription hearing aids, and a $205 quarterly over-the-counter allowance with no copays. Additionally, routine transportation is covered for up to 14 one-way trips per year with no copay or coinsurance.
Inpatient Hospital See details
Anthem Dual Advantage 2 (PPO D-SNP) partially covers inpatient hospital services, with a $275 copay per day for days 1 through 7, no copay for days 8 through 90, and no coinsurance. Non-Medicare-covered stays and acute hospital upgrades are not covered.
Outpatient Services See details
Anthem Dual Advantage 2 (PPO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services, with a 20% coinsurance and no copay. Outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Dual Advantage 2 (PPO D-SNP) with a $55 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Anthem Dual Advantage 2 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering no copay and no coinsurance for up to 14 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Dual Advantage 2 (PPO D-SNP) covers emergency services with a $90 copay and urgently needed services with a $40 copay, both with no coinsurance. The plan also features worldwide emergency, urgent, and transportation coverage up to a $100,000 limit with no copays or coinsurance.
Primary Care See details
Anthem Dual Advantage 2 (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with a 20% coinsurance and no copay. Chiropractic services are partially covered with a 20% coinsurance and no copay, as routine chiropractic care is not covered. Additional telehealth and Medicare-covered podiatry are available with no copay and no coinsurance, while routine foot care requires a 20% coinsurance and no copay.
Preventive Services See details
Anthem Dual Advantage 2 (PPO D-SNP) features partially covered preventive services, offering no copay and no coinsurance for annual physicals, kidney disease education, and personal emergency response systems. A 20% coinsurance and no copay apply to glaucoma screenings and diabetes self-management training. Uncovered services include health education, in-home safety assessments, medical nutrition therapy, in-home medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling services.
Hearing Services See details
Anthem Dual Advantage 2 (PPO D-SNP) covers hearing services with no deductible, offering one routine hearing exam per year with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. OTC hearing aids are also covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Anthem Dual Advantage 2 (PPO D-SNP) offers partially covered vision services, with eyewear upgrades excluded from coverage. Routine eye exams have no copay and a 20% coinsurance, up to a $69 annual limit. Covered eyewear has a $225 annual limit with no copay, carrying a 20% coinsurance for contact lenses and no coinsurance for eyeglasses.
Dental Services See details
Dental services are partially covered by Anthem Dual Advantage 2 (PPO D-SNP), which offers up to $1,500 annually for most preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Dual Advantage 2 (PPO D-SNP) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Dual Advantage 2 (PPO D-SNP) plan with 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment is covered by Anthem Dual Advantage 2 (PPO D-SNP) with no copays across all categories. Durable medical equipment requires no coinsurance to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment is covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Dual Advantage 2 (PPO D-SNP) with no copay and a 20% coinsurance. Covered services include diagnostic procedures, lab tests, therapeutic radiology, and outpatient X-rays, all of which require prior authorization.
Home Health Services See details
Anthem Dual Advantage 2 (PPO 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 not covered under the Anthem Dual Advantage 2 (PPO D-SNP) plan, as no coverage is provided for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Anthem Dual Advantage 2 (PPO D-SNP), requiring prior authorization but featuring no copay for days 1 through 20, a $214 daily copay for days 21 through 100, and no coinsurance. While the plan does not require a 3-day prior hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Anthem Dual Advantage 2 (PPO D-SNP) plan, as acupuncture and dual eligible SNPs with highly integrated services are not covered. Covered services, including meal benefits, community resource support, and up to $205 every three months for over-the-counter items, are provided with no copay or coinsurance.
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