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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 Kentucky. 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 $37.70. 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 $4900.00 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. After the 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, the plan's premium may be reduced to $37.70. 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. Hospital stays have a copay, while many outpatient services have either a copay or no cost. Preventive, hearing, and vision services have some coverage with no copay, while dental services have a $2,000 annual maximum. Ambulance, emergency, and primary care services are covered, and the plan offers additional benefits like over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $375 for days 1-6, and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $375 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services, with individual and group sessions both having a copay of $35. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Dual Advantage (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 $260 copay, 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. For Emergency Services, there is a $125 copay, and for Urgently Needed Services, there is a $20 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
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, and occupational therapy services have a $35 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may have a copay depending on the service. Fitness benefits, Personal Emergency Response System (PERS), Remote Access Technologies, and Home and Bathroom Safety Devices have no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, 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 Services include coverage for hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with a $0 copay and a combined maximum benefit of $250 per year. 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, with a maximum benefit of $2,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with 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 Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and 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 and tests with a copay between $0 and $25, and lab services with no copay. Radiological services are covered, including diagnostic radiological services with a copay between $50 and $150, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $50 copay.
Home Health Services See details
Home Health Services are covered by Anthem Dual Advantage (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Dual Advantage (HMO D-SNP) plan. While the plan covers Cardiac Rehabilitation Services, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Dual Advantage (HMO D-SNP) plan. For days 1-20, there is no copay, while for days 21-100, the copay is $214.
Other Services See details
The Anthem Dual Advantage (HMO D-SNP) plan covers over-the-counter items with no copay and a maximum benefit coverage amount of $50 per month, and a meal benefit with 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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