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Anthem HealthPlus Full Dual Advantage (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 (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Anthem HealthPlus 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 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 (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 (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 (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 (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 (HMO D-SNP)
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Drug Coverage
The Anthem HealthPlus Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard retail pharmacies and through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies of these medications. For other drug categories, including Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for all supply durations. Tier 5 specialty drugs also carry a 25% coinsurance, which is restricted to a one-month supply. This straightforward cost structure helps you easily anticipate your out-of-pocket medication expenses.
Additional Benefits
The Anthem HealthPlus Full Dual Advantage (HMO D-SNP) offers robust coverage with no copay or coinsurance for inpatient hospital stays and skilled nursing facility care. For outpatient services, primary care, and specialist visits, members generally pay no copay alongside a 20% coinsurance. Emergency room visits require a $115 copay, while urgent care services carry a $40 copay, both with no coinsurance. Preventive dental, routine hearing, and vision care are highly accessible, featuring no copay and generous annual allowances for hearing aids and eyewear. Additionally, the plan provides valuable extra benefits such as routine non-emergency transportation, home health services, and over-the-counter items with no copay or coinsurance. Many of these services, including diagnostics and durable medical equipment, feature no copay with coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) partially covers inpatient hospital services with no copay or coinsurance for acute and psychiatric stays, though prior authorization is required. This coverage does not include upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers outpatient services with no copay, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem HealthPlus Full Dual Advantage (HMO D-SNP), with ground and air ambulance rides requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Anthem HealthPlus Full Dual Advantage (HMO D-SNP) with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a $100,000 maximum plan benefit limit.
Primary Care See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also covered with no copay and no coinsurance.
Preventive Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, fitness, and home safety devices with no copay and no coinsurance. Other preventive screenings, such as glaucoma and diabetes self-management training, are covered with no copay and a 20% coinsurance, while sub-services like health education, nutritional benefits, and alternative therapies are not covered.
Hearing Services See details
Hearing services are covered by Anthem HealthPlus Full Dual Advantage (HMO D-SNP) with no deductible, including routine exams for no copay and 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay or coinsurance, excluding inner ear, outer ear, and over the ear types, while over-the-counter hearing aids are covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision Services are partially covered by Anthem HealthPlus Full Dual Advantage (HMO D-SNP), with other eye exam services and eyewear upgrades excluded. Routine eye exams and contact lenses feature no copay with a 20% coinsurance, while eyeglasses, lenses, and frames have no copay or coinsurance under a $300 annual limit with no deductible.
Dental Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance, while comprehensive and most preventive dental services are covered with no copay and no coinsurance. Dental services are partially covered because fluoride treatments are not covered.
Home Infusion bundled Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs carry no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is available for a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics 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
Diagnostic and radiological services are covered under the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This includes coverage for diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization required, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Anthem HealthPlus Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay, though prior authorization is required. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem HealthPlus Full Dual Advantage (HMO D-SNP) covers other services such as acupuncture up to 24 treatments yearly, over-the-counter items, chronic illness meals, and Medicare community resource support with no copay and no coinsurance. Highly integrated services for dual-eligible SNPs and certain other miscellaneous services are not covered under this benefit.
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