Anthem Full Dual Advantage (PPO D-SNP)
Anthem Full Dual Advantage (PPO D-SNP) H4036-032 Plan Details
Anthem Full Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-032
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$0.00
Monthly Premium
Anthem Full Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-032
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Anthem Full Dual Advantage (PPO D-SNP) H4036-032 Plan Details
Anthem Full Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-032
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$0.00
Monthly Premium
Georgia Counties Served
Coweta
Carroll
Oconee
Baldwin
Turner
Tattnall
Peach
Candler
Dodge
Clinch
Clarke
Johnson
Elbert
Spalding
Ben Hill
Muscogee
Towns
Paulding
Baker
Oglethorpe
Polk
Effingham
Houston
Chattahoochee
Chatham
Franklin
Screven
Tift
Russell
Mcduffie
Pierce
Gwinnett
Brantley
Dooly
Rabun
Clayton
Meriwether
Bulloch
Evans
Coffee
Emanuel
Butts
Upson
Cobb
Bleckley
Schley
Taylor
Richmond
Stewart
Murray
Bartow
Long
Rockdale
Charlton
Jasper
Wilkes
Union
Marion
Henry
Jenkins
Greene
Glascock
Toombs
Quitman
Laurens
Crisp
Ware
Jones
Fulton
Stephens
Pickens
Wayne
Montgomery
Putnam
Madison
Warren
Habersham
Heard
Harris
Atkinson
Bryan
Jackson
Jefferson
Pike
Mcintosh
Hall
Monroe
Fannin
Walton
Banks
Twiggs
Burke
Lowndes
Talbot
Appling
Hancock
Barrow
Catoosa
Douglas
Morgan
Newton
Lincoln
Haralson
Taliaferro
Columbia
Bacon
Lamar
Pulaski
Washington
Webster
Wilcox
Bibb
Macon
Wilkinson
Telfair
Liberty
Hart
Dawson
Chattooga
Gilmer
Troup
Cherokee
Crawford
Forsyth
Irwin
Lumpkin
White
Dekalb
Treutlen
Wheeler
Jeff Davis
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $8850 Out-of-Network: N/A |
| Initial Coverage Limit | $5030 |
| Catastrophic Coverage Limit | $8,000 |
| Primary Care Doctor Visit | In-Network: $0.00 copay Out-of-Network: $0.00 copay - 40% coinsurance |
| Specialty Doctor Visit | In-Network: $0.00 copay Out-of-Network: $0.00 copay - 40% coinsurance |
| Inpatient Hospital Care | In-Network: $0.00 copay per stay Additional Hospital Days: Unlimited additional days Out-of-Network: Days 1-5: $0.00 - $305.00 per day, per admission / Days 6-90: $0.00 per day, per admission |
| Urgent Care | Urgent Care: $0.00 copay |
| Emergency Room Visit | Emergency Care: $0.00 copay Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year. |
| Ambulance Transportation | In-Network: Ground Ambulance: $0.00 copay Air Ambulance: $0.00 copay Out-of-Network: $0.00 copay - 20% coinsurance for each covered, one-way ambulance trip by ground or water. $0.00 copay -20% coinsurance for each air ambulance trip. |
Health Care Services and Medical Supplies
Anthem Full Dual Advantage (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Medicare Covered Chiropractic Services: $0.00 copay Out-of-Network: Medicare Covered Chiropractic Services: $0.00 copay - 40% coinsurance |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: $0.00 copay Out-of-Network: $0.00 copay |
| Durable Medical Eqipment (DME) | In-Network: $0.00 copay Out-of-Network: $0.00 copay - 40% coinsurance |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay X-Rays: $0.00 copay Therapeutic Radiological Services: $0.00 copay Outpatient Diagnostic Procedures/Tests: $0.00 copay Diagnostic Radiological Services: $0.00 copay Out-of-Network: Lab Services: $0.00 copay - 40% coinsurance X-Rays: $0.00 copay - 40% coinsurance Therapeutic Radiological Services: $0.00 copay - 40% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - 40% coinsurance Diagnostic Radiological Services: $0.00 copay - 40% coinsurance |
| Home Health Care | In-Network: $0.00 copay Out-of-Network: $0.00 copay |
| Mental Health Inpatient Care | In-Network: $0.00 copay per stay Additional Hospital Days: Unlimited additional days Out-of-Network: Days 1-5: $0.00 - $305.00 per day, per admission / Days 6-90: $0.00 per day, per admission |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $0.00 copay Out-of-Network: $0.00 copay - 40% coinsurance |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $0.00 copay Observation Services: $0.00 copay Ambulatory Surgical Center: $0.00 copay Out-of-Network: Outpatient Hospital - Surgery: $0.00 copay - 40% coinsurance Observation Services: $0.00 copay - 40% coinsurance Ambulatory Surgical Center: $0.00 copay - 40% coinsurance |
| Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $0.00 copay Out-of-Network: $0.00 copay - 40% coinsurance |
| Podiatry Services | In-Network: Medicare Covered Podiatry Services: $0.00 copay Routine Foot Care: $0.00 copay Unlimited routine foot care visits each year. Out-of-Network: Medicare Covered Podiatry Services: $0.00 copay - 40% coinsurance Routine Foot Care: $0.00 copay |
| Skilled Nursing Facility Care | In-Network: $0.00 copay per stay Out-of-Network: Days 1 - 20: $0.00 per day / Days 21 - 100: $0.00 - $196.00 per day |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Preventive and Comprehensive Dental Combined Allowance This plan covers up to $4,000 for covered preventive and comprehensive dental services every year. Medicare Covered Dental: $0.00 copay Preventive Dental Services: $0.00 copay Comprehensive Dental Services: $0.00 copay Out-of-Network: Medicare Covered Dental Services: Coinsurance for Medicare Covered Comprehensive Dental 40% Non-Medicare Covered Dental Services: Copayment for Non-Medicare Covered Preventive Dental $0.00 Copayment for Non-Medicare Covered Comprehensive Dental $0.00 |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. $69.00 maximum eye exam coverage amount. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay This plan covers up to $425.00 for eyeglasses or contact lenses every year. Out-of-Network: Medicare Covered Eye Exam: $0.00 copay - 40% coinsurance Routine Eye Exam: $0.00 copay Medicare Covered Eye Wear: $0.00 copay - 40% coinsurance Routine Eye Wear: $0.00 copay |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Medicare Covered Hearing Exam: $0.00 copay Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam up to a $59.00 maximum plan benefit every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum plan benefit for prescribed hearing aids every year. Out-of-Network: Medicare Covered Hearing Exam: $0.00 copay - 40% coinsurance Routine Hearing Exam: $0.00 copay for routine hearing exam(s). |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services Out-of-Network: $0.00 copay - 40% coinsurance |
Prescription Drug Costs and Coverage
The Anthem Full Dual Advantage (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $0 |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|
| Non-Preferred Drug |
|
| Specialty Tier |
|
| Select Care Drugs |
|
| Annual Drug Deductible | $0 |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|
| Non-Preferred Drug |
|
| Specialty Tier |
|
| Select Care Drugs |
|
| Annual Drug Deductible | $0 |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|
| Non-Preferred Drug |
|
| Specialty Tier |
|
| Select Care Drugs |
|
