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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 2026, 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 3.5 out of 5 stars in 2026.
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 $0.00. 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:
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Drug Coverage
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no copay benefit applies to one-month, two-month, and three-month supplies. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for standard pharmacy and standard mail order fills. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply. This clear cost-sharing structure helps you understand your out-of-pocket costs for brand-name and specialty medications.
Additional Benefits
The Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) offers comprehensive coverage featuring no copays for many essential medical services. Beneficiaries enjoy inpatient hospital stays, skilled nursing facility care, and home health services with no copay and no coinsurance. However, outpatient services, doctor visits, and diagnostic testing typically require a 20% coinsurance and no copay. For routine care, the plan provides dental, vision, and hearing benefits with no copays. Preventive dental and eyewear are covered with no coinsurance up to annual limits of $2,000 and $300 respectively, and prescription hearing aids are covered up to $3,000. Members also benefit from up to 40 one-way transportation trips per year and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, subject to prior authorization. Some sub-services, including additional inpatient days, non-Medicare-covered stays, and room upgrades, are not covered under this plan.
Outpatient Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers outpatient services with no copayments, though a 20% coinsurance and prior authorization apply to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem I MaineHealth Advantage Dual Plus (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
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem I MaineHealth Advantage Dual Plus (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, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while select telehealth services are available with no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) partially covers preventive services, offering annual physical exams, kidney disease education, and select supplemental benefits like fitness, PERS, remote access, and home safety devices with no copay and no coinsurance. Other preventive benefits, including glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs, feature no copay and a 20% coinsurance. Sub-services not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge 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 counseling, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers hearing services with no deductible, featuring annual routine exams for no copay and 20% coinsurance, and fitting evaluations for no copay or coinsurance. Prescription hearing aids are covered up to $3,000 annually and OTC hearing aids up to $300 annually with no copays or coinsurance, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP), excluding other eye exam services and eyewear upgrades. Routine eye exams (one per year) and contact lenses have no copay and 20% coinsurance, while eyeglasses, lenses, and frames feature no copay and no coinsurance up to a $300 annual limit.
Dental Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) provides partially covered dental services, with maxillofacial prosthetics, implant services, and orthodontics not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers medical equipment with no copays, though coinsurance requirements vary by item. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic supplies and services are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) with no copay, but require a 20% coinsurance and prior authorization. This coverage includes diagnostic procedures, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers some cardiac rehabilitation services with no copay and prior authorization, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. This benefit allows for admission with less than a three-day prior inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) plan, with acupuncture not being covered. Covered services, including over-the-counter (OTC) items, meal benefits, and Medicare Community Resource Support, are available with no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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