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Anthem Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem 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 GA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem 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 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 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 Dual Advantage (HMO 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 $355.00 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:
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Drug Coverage
The Anthem Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $355. Under this plan, enrollees benefit from no copay on Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. This coverage provides affordable access to many common and essential medications. For other drug tiers, costs are structured as coinsurance rather than flat copays. You will pay a 25% coinsurance for Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs through standard pharmacy or mail order services. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. For more specialized medical needs, members pay no coinsurance, though copays apply, such as a $300 copay for days 1 through 6 of inpatient hospital stays and up to a $40 copay for specialist visits. Emergency care is accessible with a $115 copay, while urgent care requires a $25 copay, both with no coinsurance. This plan also includes valuable everyday supplemental benefits with no copays or coinsurance, including up to $1,600 annually for dental care, a $225 annual allowance for eyewear, and up to $2,000 yearly for prescription hearing aids. Additionally, members can access up to 60 free one-way transportation trips per year to plan-approved locations and receive covered over-the-counter items with no copay. Durable medical equipment and dialysis services are covered with no copays and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem Dual Advantage (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required for these services, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient services with no coinsurance, featuring copays that range from no copay up to $300 for outpatient hospital services and $300 per stay for observation services. Outpatient substance abuse sessions require a $40 copay, while ambulatory surgical center and outpatient blood services are fully covered with no copays.
Partial Hospitalization See details
Anthem Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Dual Advantage (HMO D-SNP), featuring a $275 copay and no coinsurance for ground and air ambulance services. The plan also provides up to 60 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered up to a $100,000 maximum benefit limit with a $115 copay and no coinsurance per service.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) covers primary care physician visits and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require copays up to $40 with no coinsurance. Although chiropractic services are technically covered with a $15 copay and no coinsurance, routine and other chiropractic sub-services are not covered in practice.
Preventive Services See details
Anthem Dual Advantage (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering fitness benefits, remote access technologies, and home safety devices with no copay and no coinsurance, while sub-services like health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Anthem Dual Advantage (HMO D-SNP) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, though inner ear, outer ear, and over the ear types are not covered, and over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance up to $300 annually.
Vision Services See details
Vision services are partially covered by Anthem Dual Advantage (HMO D-SNP), which offers one routine eye exam annually and eyewear up to a $225 yearly limit with no copay, no coinsurance, and no deductible. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Dual Advantage (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance up to a $1,600 annual maximum. While many preventive and comprehensive dental services are covered, this plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Anthem Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Anthem Dual Advantage (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetic devices or medical supplies with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes, is also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Dual Advantage (HMO D-SNP) with prior authorization required, featuring no coinsurance for diagnostic services and no copays for lab services or outpatient X-rays. Diagnostic procedures and tests carry a copay of $0 to $100, diagnostic radiological services have a minimum $0 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Anthem Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Under the Anthem Dual Advantage (HMO D-SNP) plan, some cardiac rehabilitation services are covered with no copay and no coinsurance, requiring prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not necessary, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Anthem Dual Advantage (HMO D-SNP) partially covers other services, offering Over-the-Counter (OTC) items and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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