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Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I MaineHealth Advantage Dual Plus (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 I MaineHealth Advantage Dual Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in State of Maine. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I MaineHealth Advantage Dual Plus (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 I MaineHealth Advantage Dual Plus (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 I MaineHealth Advantage Dual Plus (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 I MaineHealth Advantage Dual Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.20. 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 I MaineHealth Advantage Dual Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $11.20. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as routine eye exams, prescription hearing aids, and home health services, are available with no copay. Other services, including outpatient hospital services, emergency services, and diagnostic services, may require a copay or coinsurance, with some services having a 20% coinsurance. This plan also covers essential services like dental, vision, and hearing, with specific cost structures for each. Dental services include no copay for many services, while vision services offer no copay for routine eye exams. Hearing services cover hearing exams and hearing aids with no copay for prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. However, additional days, non-Medicare-covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered, with a 20% coinsurance for outpatient hospital and observation services. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I MaineHealth Advantage Dual Plus (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. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay. 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, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services require a 20% coinsurance, except for additional telehealth benefits, which have no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, such as Fitness Benefit, Personal Emergency Response System, Remote Access Technologies, and Home and Bathroom Safety Devices, that may have a copay. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, which have a 20% coinsurance.
Hearing Services See details
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20% for routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, with a maximum benefit of $3,000 per year. OTC hearing aids are covered with no copay, up to a maximum of $300 per year.
Vision Services See details
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Routine eye exams have no copay, while eyewear has a 20% coinsurance, and contact lenses, eyeglasses, and eyeglass lenses and frames have no copay.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a 20% coinsurance, and other dental services with a maximum plan benefit of $2250 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, but not for DME used outside the home. Prosthetics and Medical Supplies have no copay, and a 20% coinsurance for Medicare-covered services. Diabetic Equipment has no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan with no copay and no coinsurance, although additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem I MaineHealth Advantage Dual Plus (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 additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and coinsurance information is available in the plan details.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, Meal Benefit, and Medicare Community Resource Support. Over-the-Counter (OTC) Items have no copay, and the plan offers a monthly benefit for OTC items. Meal Benefits and Medicare Community Resource Support have no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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