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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 2026, 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 2026.
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 $3.60. 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 Full Dual Advantage (HMO D-SNP)
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Drug Coverage
The Anthem Full Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at standard retail pharmacies or through standard mail-order services. For other medication tiers, the plan utilizes a coinsurance structure rather than a flat copayment. You will pay a 25% coinsurance for Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs across all supply lengths. Tier 5 specialty drugs also carry a 25% coinsurance, which is restricted to a one-month supply at standard pharmacies and mail order.
Additional Benefits
The Anthem Full Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage, with many essential services requiring no copayments. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. However, outpatient hospital visits, primary care, specialist consultations, and diagnostic services generally carry a 20% coinsurance with no copay, while emergency room visits require a $115 copay. Beyond basic medical care, this plan provides valuable supplemental benefits with no deductibles for dental, vision, and hearing services. Routine eye exams, dental care, and hearing aids are covered with no copay, featuring generous annual allowances such as up to $3,000 for dental services and prescription hearing aids. Members also receive extra support with no copay or coinsurance, including 48 one-way transportation trips per year and a $175 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric care, although prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under these benefits.
Outpatient Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers outpatient services with no copays, though 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
Anthem Full Dual Advantage (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Full Dual Advantage (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered with no copay and no coinsurance, providing up to 48 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with no copays and no coinsurance.
Primary Care See details
Anthem Full Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, podiatry, and opioid treatment services with no copay and a 20% coinsurance, though chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance.
Preventive Services See details
Preventive Services under the Anthem Full Dual Advantage (HMO D-SNP) are covered with no copay and no coinsurance for annual physicals, kidney disease education, memory fitness, and remote access, while glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs require a 20% coinsurance with no copay. This benefit is partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem Full Dual Advantage (HMO D-SNP) covers hearing services with no deductible, including routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually for both ears combined, though inner ear, outer ear, and over the ear devices are not covered. OTC hearing aids are also covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision Services are partially covered by Anthem Full Dual Advantage (HMO D-SNP) with no deductibles, offering one routine eye exam annually and contact lenses with no copay and 20% coinsurance, plus eyeglasses with no copay or coinsurance up to a $350 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Full Dual Advantage (HMO D-SNP) partially covers dental services with no copay and a 20% coinsurance for Medicare-covered care, and no copay and no coinsurance for other dental services up to a $3,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Full Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Full Dual Advantage (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required for certain items. Durable medical equipment carries a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Anthem Full Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This coverage includes outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and X-rays.
Home Health Services See details
Home Health Services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Anthem Full Dual Advantage (HMO D-SNP) with no copay and prior authorization, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Full Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Anthem Full Dual Advantage (HMO D-SNP) plan, offering no copay and no coinsurance for Medicare Community Resource Support, chronic illness meals, and up to $175 per month in over-the-counter items. Acupuncture is not covered under this benefit.
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