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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 2025, 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 out of 5 stars in 2025.
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 $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 (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $72.30. During the initial coverage phase, after you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000.00, you will enter the next coverage phase.
Additional Benefits
The Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing options. Many services, like primary care, outpatient services, and vision services, require a coinsurance, typically 20%, while some services have a copay. The plan also offers benefits with no copay, including preventive services like annual physical exams, hearing exams, and dental services. This plan provides coverage for emergency services with copays, and covers ambulance and transportation services with a coinsurance or no copay, depending on the service. Other notable benefits include coverage for home health services, medical equipment, and diagnostic services. Additionally, the plan includes some unique offerings such as acupuncture, over-the-counter items, and a meal benefit, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered and require prior authorization. The plan follows the cost sharing of Original Medicare, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and 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, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a coinsurance of 20%. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 36 one-way trips per year.
Emergency Services See details
Emergency Services include a $110 copay, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Services have a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan covers primary care services, including primary care physician services, chiropractic services, occupational therapy, 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. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, individual and group sessions for mental health and psychiatric services, and routine foot care have a 20% coinsurance. Additional telehealth benefits have no copay. Medicare-covered podiatry services have no copay.
Preventive Services See details
Preventive Services include no copay for annual physical exams, and additional services with a copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit have a 20% coinsurance. Health education, in-home safety assessments, 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, telemonitoring services, and counseling services are not covered. Personal Emergency Response System (PERS), fitness benefit, remote access technologies (including web/phone-based technologies and nursing hotline), and home and bathroom safety devices and modifications are covered with no copay. Kidney disease education services are covered with a copay.
Hearing Services See details
The Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance for routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $3,000 per year with no copay for all types of hearing aids, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are covered with no copay up to a maximum of $300 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, but upgrades are not covered.
Dental Services See details
Dental Services are covered under the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan. Medicare Dental Services have 20% coinsurance, and other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, and restorative services, all with no copay, as well as orthodontics with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and other Medicare Part B drugs including chemotherapy/radiation drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan, including Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance, as well as Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem HealthPlus Full Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice, as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and coinsurance may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the coinsurance is not specified in this summary. Additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services include acupuncture with no copay, and a limit of 24 treatments per year; over-the-counter items with no copay, and a monthly benefit; and a meal benefit with no copay. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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