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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 2026, 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 GA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $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 $520.00 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 Full Dual Advantage (HMO D-SNP) plan features an annual drug deductible of $520. Members pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This zero-dollar cost sharing applies to all one-month, two-month, and three-month supply options. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, the plan charges a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs require a 27% coinsurance for a one-month supply.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For outpatient hospital visits, primary care, specialist consultations, and diagnostic services, members generally pay no copay alongside a 20% coinsurance. Emergency care is accessible with a $115 copay, while urgent care requires a $20 copay, both featuring no coinsurance. Additional benefits include dental, vision, and hearing services, which feature no deductibles and no copays, though certain routine exams and comprehensive services carry a 20% coinsurance. The plan also covers up to 60 one-way transportation trips to approved health locations and provides over-the-counter items with no copay and no coinsurance. Furthermore, durable medical equipment and diabetic supplies are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Additional days, non-Medicare-covered stays, and upgrades are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan with no copays, though a 20% coinsurance and prior authorization apply to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Anthem Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance, providing up to 60 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $20 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, and podiatry services with no copay and 20% coinsurance, while telehealth benefits have no copay and no coinsurance. Chiropractic services are not covered in practice, and prior authorization is required for most specialized treatments.
Preventive Services See details
Anthem Full Dual Advantage (HMO D-SNP) features partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, memory fitness, remote access, and home safety devices. Glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs are covered with no copay and 20% coinsurance, but sub-services like health education, PERS, nutritional therapy, in-home safety assessments, and alternative therapies are not covered.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, offering routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually, excluding inner ear, outer ear, and over-the-ear types, while OTC hearing aids are covered with no copay or coinsurance up to $300 annually.
Vision Services See details
Anthem Full Dual Advantage (HMO D-SNP) provides partially covered vision services with no deductibles, including one annual routine eye exam with no copay and 20% coinsurance, though other eye exam services are not covered. Covered eyewear is subject to a $300 annual limit, offering eyeglasses with no copay and no coinsurance, and contact lenses with no copay and 20% coinsurance, while upgrades are not covered.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers dental services with no copay and a 20% coinsurance for Medicare-covered care, and no copay or coinsurance for preventive and comprehensive services up to a $4,000 yearly limit. While most restorative and preventive treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Full Dual Advantage (HMO D-SNP) covers durable medical equipment and prosthetics with no copays and coinsurance ranging from 0% to 20%. Diabetic equipment, supplies, and therapeutic shoes are also covered under this plan with no copays and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. This coverage applies to outpatient diagnostic procedures, lab services, therapeutic radiology, and X-rays.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Full Dual Advantage (HMO D-SNP) offers no copay for Cardiac Rehabilitation Services, but the benefit is not covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services all require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem Full Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items, chronic illness meal benefits, and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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