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Anthem Full Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Full Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem 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 Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem 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 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 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 Full Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.50. 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 Full Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your monthly premium for Part D will be $38.50. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services have no copay, including preventive services like annual physical exams, hearing aid fittings, and specific vision and dental services. Other services, like inpatient and outpatient services, primary care, and some vision and dental services, have a coinsurance of 20%. This plan covers a range of services, from emergency and ambulance services to home health and medical equipment. The plan also offers additional benefits such as over-the-counter items with a monthly allowance, and meal benefits. It is important to review the plan details for specific copays and coinsurance amounts for each service.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Full Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Full Dual Advantage (HMO D-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Full Dual Advantage (HMO D-SNP) plan covers 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, 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 have a 20% coinsurance. Occupational therapy, individual and group sessions for mental health and psychiatric services, and other healthcare professional services have a 20% coinsurance. Routine Foot Care has a 20% coinsurance. Additional telehealth benefits have no copay. Medicare-covered podiatry services have no copay.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and other preventive services with a copay and 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, and telemonitoring services are not covered. Additional preventive services include Personal Emergency Response System (PERS) with no copay, Fitness Benefit with no copay, Remote Access Technologies with no copay, Home and Bathroom Safety Devices and Modifications with no copay, and Kidney Disease Education Services with no copay. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with at most 20% coinsurance, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with no copay up to a maximum 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
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, and the plan covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames with no copay.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other dental services have a $4,000 maximum benefit per year, and oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and other Medicare Part B drugs. Medicare Part B insulin drugs have a $35 copay, and Medicare Part B chemotherapy/radiation and other drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment and prosthetics/medical supplies, is covered under the Anthem Full Dual Advantage (HMO D-SNP) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%; however, DME for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies also have a 20% coinsurance. Diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services, are covered. There is no copay for any of these services, but you will pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem 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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. This benefit requires prior authorization, and the coinsurance amount is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and coinsurance applies; other cost-sharing details are not provided.
Other Services See details
Other Services include over-the-counter items, meal benefits, and Medicare Community Resource Support. Over-the-counter items have no copay and a maximum benefit of $175 per month. 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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