A non-government entity
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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan features an annual prescription drug deductible of $615. Plan members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs purchased through standard pharmacies or standard mail order. This zero-cost benefit applies to one-month, two-month, and three-month supplies of these medications. For other prescription tiers, a flat 25% coinsurance applies to standard pharmacy and standard mail-order fills. This 25% coinsurance covers Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs for up to a three-month supply, as well as Tier 5 specialty drugs for a one-month supply. Understanding these costs helps you plan your healthcare budget effectively under this Anthem Medicare plan.
Additional Benefits
The Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan offers robust coverage with many essential medical services requiring no copay. Inpatient hospital stays, skilled nursing facility care, and home health services are fully covered with no copay and no coinsurance. On the other hand, outpatient care, doctor visits, diagnostic tests, and dialysis generally require a 20% coinsurance and no copay, while emergency room visits carry a $115 copay. For extra wellness benefits, this plan provides preventive dental care, select acupuncture, and up to 60 one-way transportation trips per year with no copay and no coinsurance. Routine vision and hearing exams are available with no copay and a 20% coinsurance, alongside generous annual allowances of up to $375 for eyewear and up to $4,000 for prescription hearing aids. This combination of low copays and strong supplemental coverage helps members manage their healthcare costs effectively.
Inpatient Hospital See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance, though prior authorization is required for acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers outpatient services 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
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers partial hospitalization services 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 (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem HealthPlus Full Dual Advantage LTSS (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 care, and emergency transportation services are also covered with no copays and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Primary Care benefits through Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) generally require no copay and a 20% coinsurance for services such as primary care, specialist visits, psychiatric care, and physical therapy. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance while other chiropractic services are not covered, and telehealth benefits are available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP), featuring Medicare-covered preventive care, kidney disease education, memory fitness, remote access technologies, and home safety modifications with no copays and no coinsurance. Covered services like glaucoma screenings, diabetes self-management training, digital rectal exams, and post-Welcome Visit EKGs require no copay but have a 20% coinsurance. Non-covered services include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers routine hearing exams with a 20% coinsurance, no copay, and no deductible, plus fitting evaluations with no copay, coinsurance, or deductible. Prescription hearing aids are partially covered with no copay, coinsurance, or deductible up to $4,000 annually (inner, outer, and over-the-ear types are not covered), and OTC hearing aids are covered with no copay, coinsurance, or deductible up to $300 annually.
Vision Services See details
Vision services are partially covered under the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan, which offers one annual routine eye exam with no copay and a 20% coinsurance, though other eye exams are not covered. Eyewear is covered up to $375 annually with no deductible, featuring contact lenses with no copay and a 20% coinsurance, eyeglasses with no copay, and no coverage for upgrades.
Dental Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) offers partially covered dental services, with Medicare-covered dental care requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental benefits are covered with no copay and no coinsurance, although fluoride treatment is not covered.
Home Infusion bundled Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers diagnostic and radiological services, including lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Home Health Services are covered by Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and are subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) include acupuncture, over-the-counter (OTC) items, chronic illness meals, and Medicare Community Resource Support. These benefits are provided with no copay and no coinsurance, though acupuncture is limited to 24 treatments per year and requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved