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Anthem Full Dual Advantage (PPO D-SNP)

3 out of 5 stars* for plan year 2024
$0.00 Monthly Premium

Anthem Full Dual Advantage (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield

Plan ID: H2836-006-000

$0.00 Monthly Premium

Connecticut Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Connecticut Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$8,850.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visitIn-Network:
$0.00 copay
Specialty doctor visit
Out-of-Network:
$0.00 copay - 40% coinsurance
Inpatient hospital care
Out-of-Network:
Days 1-5: $0.00 - $305.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Urgent careUrgent Care: $0.00 copay
Emergency room visitEmergency 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 transportationIn-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 a range of additional benefits. Learn more about Anthem Full Dual Advantage (PPO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:
Medicare Covered Chiropractic Services: $0.00 copay
Diabetes supplies, training, nutrition therapy and monitoring
Out-of-Network:
$0.00 copay
Durable medical equipment (DME)
Out-of-Network:
$0.00 copay - 40% coinsurance
Diagnostic tests, lab and radiology services, and X-raysIn-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
Home health care
Out-of-Network:
$0.00 copay
Mental health inpatient careIn-Network:
$0.00 copay per stay
Additional Hospital Days: Unlimited additional days
Mental health outpatient care
Out-of-Network:
$0.00 copay - 40% coinsurance
Outpatient services/surgery
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 careIn-Network:
Individual and Group Sessions: $0.00 copay
Over-the-counter itemsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $140 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.
Podiatry services
Out-of-Network:
Medicare Covered Podiatry Services: $0.00 copay - 40% coinsurance
Routine Foot Care: $0.00 copay
Skilled Nursing Facility (SNF) care
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, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental care
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, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefits
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, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefitsIn-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.

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programs
Out-of-Network:
$0.00 copay - 40% coinsurance

When reviewing Connecticut Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Connecticut that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Connecticut Counties Served

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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