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Anthem Full Dual Advantage 2 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Full Dual Advantage 2 (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 2 (HMO D-SNP) in 2025, please refer to our full plan details page.
Anthem Full Dual Advantage 2 (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 WI. 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 2 (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 2 (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 2 (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 2 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.50. 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 2 (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. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). With LIS, you will pay $43.50 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem Full Dual Advantage 2 (HMO D-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services, such as outpatient blood services, additional telehealth benefits, routine hearing exams, and fitting/evaluation for hearing aids. The plan also offers coverage for inpatient and outpatient services, emergency services, primary care, preventive services, and more. Many services have a coinsurance, including outpatient services, specialist visits, vision and dental services, and durable medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Anthem Full Dual Advantage 2 (HMO D-SNP) plan, but additional days, non-Medicare covered stays, and upgrades for acute and psychiatric care are not covered. Prior authorization is required, and coinsurance applies for covered services; more details on the coinsurance can be found in the plan documents.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Full Dual Advantage 2 (HMO D-SNP) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Full Dual Advantage 2 (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location have no copay, with a limit of 65 one-way trips per year, and include rideshare, bus/subway, van, and medical transport. 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 by Anthem Full Dual Advantage 2 (HMO D-SNP). Emergency Services have a $90 copay, and Urgently Needed Services have a $20 copay, both with no coinsurance. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no coinsurance.
Primary Care See details
The Anthem Full Dual Advantage 2 (HMO D-SNP) plan covers primary care physician services, chiropractic services (with 20% coinsurance), occupational therapy services (with 20% coinsurance), physician specialist services (with 20% coinsurance), mental health specialty services (with 20% coinsurance), podiatry services (with 20% coinsurance), other health care professional services (with 20% coinsurance), psychiatric services (with 20% coinsurance), physical therapy and speech-language pathology services (with 20% coinsurance), additional telehealth benefits (with no copay), and opioid treatment program services (with 20% coinsurance). Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay (see plan details). Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with 20% coinsurance. The plan does not cover 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. Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Kidney Disease Education Services are also covered.
Hearing Services See details
The Anthem Full Dual Advantage 2 (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20%, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay up to a maximum of $300 per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Full Dual Advantage 2 (HMO D-SNP) plan covers vision services, including eye exams, with a 20% coinsurance. Routine eye exams have no copay, and eyewear has a 20% coinsurance, with no copay for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses. Upgrades are not covered.
Dental Services See details
The Anthem Full Dual Advantage 2 (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with no copay. Medicare dental services have a 20% coinsurance, and other dental services have a maximum benefit of $4,000 per year. All other listed dental services have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Full Dual Advantage 2 (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Anthem Full Dual Advantage 2 (HMO D-SNP) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. All services have no copay, and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Anthem Full Dual Advantage 2 (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Full Dual Advantage 2 (HMO D-SNP) plan. While Cardiac Rehabilitation Services are listed as a covered benefit, the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services 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 the plan charges the Medicare-defined cost share for tier 1, with coinsurance details available in the plan documents.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, 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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