Go Back
H4909 - 018 - 0
(3 / 5)
Anthem Dual Advantage (PPO D-SNP)is a Medicare Advantage (Part C) Special Needs Plan by Anthem Blue Cross and Blue Shield.
This page features plan details for 2024 Anthem Dual Advantage (PPO D-SNP)H4909 – 018 – 0 available in Select Counties in Virginia.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Anthem Dual Advantage (PPO D-SNP)is offered in the following locations.
Albemarle County, Virginia
Alleghany County, Virginia
Amelia County, Virginia
Click to see more locations
Plan Overview
Anthem Dual Advantage (PPO D-SNP)offers the following coverage and cost-sharing.
Special Needs Plan Type: | Dual-Eligible |
Conditions Covered: |
Insurer: | Anthem Blue Cross and Blue Shield |
Health Plan Deductible: | $0.00 |
MOOP: | $12,450 In and Out-of-network $8,300 In-network |
Drugs Covered: | Yes |
Please Note:
- This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
- Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.
Ready to sign up for Anthem Dual Advantage (PPO D-SNP)?
Premium Breakdown
Anthem Dual Advantage (PPO D-SNP)has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium.The following is a breakdown of your monthly premium with Part B costs included.
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
Please Note:
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Anthem Dual Advantage (PPO D-SNP)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $545.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Basic |
Additional Gap Coverage: | No |
Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $0.00 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
30 Day
90 Day
30 Day
90 Day
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Anthem Dual Advantage (PPO D-SNP)also provides the following benefits.
$0 |
In-network | No |
$12,450 In and Out-of-network $8,300 In-network |
No |
In-network | No |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
out-of-network Primary | 40% coinsurance per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Specialist | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
out-of-network | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
Emergency | $0 copay (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic tests and procedures | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Lab services | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic radiology services (e.g., MRI) | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient x-rays | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Hearing exam | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Hearing exam | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Hearing aids | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
In-network Occupational therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Occupational therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Physical therapy and speech and language therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Physical therapy and speech and language therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Not applicable.) (Not applicable.) |
out-of-network | 20% coinsurance (Not applicable.) (Not applicable.) |
In-network | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Foot exams and treatment | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Foot exams and treatment | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Routine foot care | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 40% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Prosthetics (e.g., braces, artificial limbs) | 40% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
out-of-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
In-network Chemotherapy | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Chemotherapy | $35 copay or 0-40% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Other Part B drugs | $35 copay or 0-40% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Part B Insulin drugs | $35 copay or 0-40% coinsurance (Authorization is required.) (Not applicable.) |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | $305 per day for days 1 through 5 $0 per day for days 6 and beyond (Authorization is required.) (Referral is not required.) |
In-network Inpatient hospital – psychiatric | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Inpatient hospital – psychiatric | $305 per day for days 1 through 5 $0 per day for days 6 and beyond (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit with a psychiatrist | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit with a psychiatrist | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | $0 per day for days 1 through 20 $196 per day for days 21 and beyond (Authorization is required.) (Referral is not required.) |
Ready to sign up for Anthem Dual Advantage (PPO D-SNP)?
Table of Contents
Get Help Enrolling
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov.We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
HealthCompare Insurance Services does not offer every plan available in your area. Currently we represent 18 organizations, which offers 52,101 products in your area.
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services Please contactMedicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Medicare has neither approved nor endorsed any information on this site.
© All rights reserved | About | Contact | Legal and Privacy