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Anthem Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem 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 Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem 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 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 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 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 Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.50. 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 $4500.00 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 Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $4.50 for Part D drugs. In the initial coverage phase, after you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $295 copay for days 1-6, and no copay for days 7-90, while outpatient services have copays ranging from $0 to $280. Emergency and primary care services are covered, and many services have no copay, including preventive, vision, dental, and home health services. The plan also provides coverage for hearing, ambulance, and transportation services, often with no copay. Additional benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with copays or coinsurance depending on the service. This plan also covers home infusion services, dialysis services, and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, you pay a $295 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $280, observation services with a $280 copay, Ambulatory Surgical Center (ASC) services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem 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, with no coinsurance. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay and are limited to 102 one-way trips per year. 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 under the Anthem 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 Dual Advantage (HMO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while routine chiropractic care is not covered. Occupational therapy services have a $25 copay. Specialist visits cost $25. Mental health and psychiatric services, as well as Opioid Treatment Program Services, have a $25 copay for individual and group sessions. Podiatry services have a copay between $0 and $25, and other health care professionals have a copay between $0 and $20. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services. Additional preventive services, kidney disease education services, and other preventive services have a $0 minimum and maximum copay. 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.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a $3,000 plan maximum per year, and OTC hearing aids are covered with no copay and a $300 plan maximum per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with a combined maximum benefit of $200 per year and no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are all covered with no copay.
Dental Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. This plan also covers orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics with no copay, and a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment includes Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $35, Lab Services with no copay, Diagnostic Radiological Services with a copay between $35 and $150, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Anthem 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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Dual Advantage (HMO D-SNP) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Dual Advantage (HMO D-SNP) plan's Other Services benefit covers over-the-counter (OTC) items and meal benefits with no copay, and also covers Medicare Community Resource Support with no copay. Acupuncture, 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, 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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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