Anthem Full Dual Advantage (PPO D-SNP)
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
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 visit | In-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 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 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 services | In-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-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 |
| Home health care | Out-of-Network: $0.00 copay |
| Mental health inpatient care | In-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 care | In-Network: Individual and Group Sessions: $0.00 copay |
| Over-the-counter items | This 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 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. |
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.
