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Anthem HealthPlus Full Dual Advantage LTSS (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 (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 (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem HealthPlus Full Dual Advantage LTSS (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 NY. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem HealthPlus Full Dual Advantage LTSS (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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 HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs associated with your drugs as described in the plan's formulary. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $72.30.
Additional Benefits
The Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing options. Many services are covered with no copay, including hearing exams, fitting/evaluation for hearing aids, routine eye exams, contact lenses, eyeglasses, Durable Medical Equipment (DME), home health services, acupuncture, and over-the-counter items. However, some services, such as outpatient services, ambulance services, and vision eyewear, have a 20% coinsurance. The plan also includes coverage for emergency services, with a $110 copay, and urgently needed services, with a $45 copay. Worldwide emergency services are covered up to $100,000. Additionally, the plan provides transportation services to health-related locations with no copay, and up to 48 one-way trips per year.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under this plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay and up to 48 one-way trips per year. Transportation services to any health-related location are not covered.
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 $45 copay, but both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000, and the following services have no copay: Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Under the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary care physician services, physician specialist services, physical therapy and speech-language pathology services have a 20% coinsurance, and routine chiropractic care has no copay and a 20% coinsurance.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar services. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. Fitness benefits, remote access technologies, and home and bathroom safety devices and modifications are covered with no copay. Kidney disease education services require a doctor referral and have no copay. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit require a referral and have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and routine hearing exams have a 20% coinsurance; prescription hearing aids (all types) and OTC hearing aids have no copay.
Vision Services See details
Vision Services include coverage for 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), eyeglass lenses, and eyeglass frames have no copay; however, upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, and orthodontics. Medicare Dental Services have a 20% coinsurance, and Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with no copay and a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem HealthPlus Full Dual Advantage LTSS (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) services are covered, but the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and has a limit of 24 treatments per year. Over-the-counter (OTC) items are covered with no copay, including nicotine replacement therapy and naloxone. Meal benefits, services for individuals with intellectual disabilities, and many other services are not covered.
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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