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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 2026 to people living in State of Connecticut. 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 $14.40. 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 $615.00 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 deductible of $615 before coverage kicks in for most drug tiers. However, members enjoy 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-cost benefit applies to one-month, two-month, and three-month supplies of these essential medications. For other prescription tiers, including Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for standard retail and mail-order fills. Tier 5 specialty drugs also require a 25% coinsurance, which is restricted to a one-month supply. This clear cost-sharing structure helps you easily plan your healthcare budget with Anthem.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket expenses, featuring no copay and no coinsurance for inpatient hospital stays, skilled nursing, and home health services. For everyday medical needs, primary care, specialist visits, and diagnostic tests are available with no copay and a standard twenty percent coinsurance. Preventive services, including annual physicals and fitness programs, are also fully covered with no copays or coinsurance. In addition to core medical care, this plan provides robust supplemental benefits such as routine dental and hearing services with no copay up to specified annual limits. Members can access up to sixty one-way transportation trips per year with no copay, as well as over-the-counter items and select diabetic supplies at no cost. Emergency care is subject to flat copays of forty dollars for urgent care and one hundred fifteen dollars for emergency room visits, with no coinsurance required.
Inpatient Hospital See details
Anthem Dual Advantage (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Anthem Dual Advantage (HMO D-SNP) covers outpatient services with no copay, though outpatient hospital, ambulatory surgical center, and outpatient substance abuse services require a 20% coinsurance and prior authorization. Outpatient blood services are fully covered under this plan with no copay and no coinsurance.
Partial Hospitalization See details
Anthem Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem 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, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, but 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 urgently needed services with a $40 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 limit of $100,000.
Primary Care See details
Anthem Dual Advantage (HMO D-SNP) covers primary care, specialist visits, mental health, therapy, and opioid treatment services with no copay and a 20% coinsurance, while telehealth benefits are provided with no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan, and prior authorization is required for most specialist and therapy services.
Preventive Services See details
Preventive Services under the Anthem Dual Advantage (HMO D-SNP) are partially covered, offering annual physical exams, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems with no copays and no coinsurance. While many supplemental services like health education and nutritional benefits are not covered, other preventive services such as glaucoma screenings and diabetes training are available with a 20% coinsurance and no copay.
Hearing Services See details
Anthem Dual Advantage (HMO D-SNP) hearing services feature no deductible, offering fitting evaluations and OTC hearing aids with no copay and no coinsurance. Routine hearing exams require a 20% coinsurance and no copay, while prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
Anthem Dual Advantage (HMO D-SNP) provides partially covered vision services, excluding eyewear upgrades and other non-routine eye exams. Routine eye exams are covered once per year with no copay and a 20% coinsurance, while eyeglasses, frames, and contact lenses are covered up to a $200 annual limit with no copay, though contact lenses require a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Anthem Dual Advantage (HMO D-SNP), as maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $1,000 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Dual Advantage (HMO D-SNP) covers medical equipment with no copays, featuring 0% to 20% coinsurance for durable medical equipment (DME) and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, including supplies and therapeutic shoes from specified manufacturers, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay and require prior authorization, though some services are not covered and instead require a 20% coinsurance. These uncovered services include intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Anthem Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan does not require a three-day prior inpatient hospital stay for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem 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 plan.
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