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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 2025, 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 2025.
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 $22.70. 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 Maximum Out-Of-Pocket cost of $9350.00 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 has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your Part D premium will be $22.70. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including preventive care, hearing aid fittings, eyewear lenses, dental services, and durable medical equipment. Other services have a coinsurance, such as outpatient services, primary care, and vision exams, typically set at 20%. Emergency services have a $110 copay, with urgent care at $20, while worldwide emergencies have no copay. The plan also includes coverage for transportation, home health, and home infusion services, with specific cost-sharing details outlined in the plan's benefits. Some services, like cardiac rehabilitation, and additional days in a skilled nursing facility, are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare covered stays, and upgrades for acute and psychiatric care are not covered. The plan's coinsurance for these services follows Original Medicare guidelines.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $20 copay, while all Worldwide Emergency Services have no copay.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, other health care professional, and opioid treatment program services have a 20% coinsurance. The plan covers podiatry services, including routine foot care, with a 20% coinsurance, and no copay. Additional telehealth benefits have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, in addition to an annual physical exam with no copay. Additional preventive services may have a copay, and other services like health education, and several others are not covered. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with at most 20% coinsurance for routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, while routine eye exams have no copay. Eyewear has a 20% coinsurance and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $4000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and other Medicare Part B drugs. 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 Full Dual Advantage (HMO D-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay, and a coinsurance between 0% and 20%, but DME for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. 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 Full Dual Advantage (HMO D-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays for SNF.
Other Services See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture is not covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services, are not covered.
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