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Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem HealthPlus Full Dual Advantage LTSS 2 (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 HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in NYC Metro, ER, NA, SU, RO, WE, NI, Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Anthem HealthPlus Full Dual Advantage LTSS 2 (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 HealthPlus Full Dual Advantage LTSS 2 (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 HealthPlus Full Dual Advantage LTSS 2 (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 HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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:
Sign up for Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP)
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Drug Coverage
The Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) prescription drug plan features an annual deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs obtained through standard pharmacies or standard mail order. This cost-sharing benefit applies to one-month, two-month, and three-month supplies of these medications. For other drug tiers, including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance rate is consistent across standard pharmacies and standard mail-order services. While Tier 5 specialty drugs are restricted to a one-month supply, Tiers 2 through 4 allow for up to a three-month supply.
Additional Benefits
The Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) offers comprehensive healthcare coverage featuring no copays for inpatient hospital stays, primary care visits, and specialist consultations, though a 20% coinsurance typically applies to outpatient and specialist services. Emergency care is accessible with a $115 copay, while urgently needed services require a $40 copay, both with no coinsurance. Additionally, skilled nursing facility stays and home health services are covered with no copay and no coinsurance, helping members manage their essential medical costs. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance. Vision and hearing needs are supported with a $375 annual eyewear allowance and up to $4,000 annually for prescription hearing aids, both featuring no copays. Members can also access acupuncture treatments and over-the-counter items with no copay and no coinsurance to support their overall wellness.
Inpatient Hospital See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) partially covers inpatient hospital services, providing acute and psychiatric care with no copay and no coinsurance. However, prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) are covered with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with no copays and no coinsurance.
Primary Care See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Additional telehealth benefits are offered with no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar preventive care, kidney disease education, memory fitness, remote access, and home safety devices with no copay and no coinsurance. Glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome-visit EKGs are covered with no copay but require a 20% coinsurance. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling services are not covered.
Hearing Services See details
Hearing services are covered by Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP), featuring routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $4,000 annually, but inner ear, outer ear, and over the ear hearing aids are not covered. Over-the-counter hearing aids are also covered up to $300 per year with no copay and no coinsurance.
Vision Services See details
Vision Services under the Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) are partially covered with no deductible, though upgrades and other non-routine eye exams are not covered. Covered benefits include one annual routine exam with no copay and a 20% coinsurance (prior authorization required), alongside a $375 yearly eyewear allowance with no copays, featuring no coinsurance for glasses and a 20% coinsurance for contacts.
Dental Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) offers Medicare-covered dental services with no copay and a 20% coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. Dental benefits are partially covered under this plan, as fluoride treatments are not covered.
Home Infusion bundled Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers medical equipment with no copays, though coinsurance and prior authorization may apply to certain items. Durable medical equipment carries up to 20% coinsurance, prosthetics and medical supplies have a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers diagnostic and radiological services with no copay, though prior authorization is required and you will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, but in practice, the benefit is not covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) partially covers other services with no copay and no coinsurance, including up to 24 acupuncture treatments per year, over-the-counter items, and Medicare Community Resource Support. Meal benefits and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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