Anthem Dual Advantage (PPO D-SNP)
Anthem Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-039
HelpAdvisor Editorial Team analysis of data from the 2025 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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Anthem Dual Advantage (PPO D-SNP) - H4036-039 by Anthem Blue Cross and Blue Shield as well as other Medicare Advantage plans available in your area.
Anthem Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-039
HelpAdvisor Editorial Team analysis of data from the 2025 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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Anthem Dual Advantage (PPO D-SNP) - H4036-039 by Anthem Blue Cross and Blue Shield as well as other Medicare Advantage plans available in your area.
Anthem Dual Advantage (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4036-039
HelpAdvisor Editorial Team analysis of data from the 2025 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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Anthem Dual Advantage (PPO D-SNP) - H4036-039 by Anthem Blue Cross and Blue Shield as well as other Medicare Advantage plans available in your area.
Georgia Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $5000 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: $0.00 copay Out-of-Network: 50% coinsurance |
| Specialty Doctor Visit | In-Network: $0.00 copay Out-of-Network: 50% coinsurance |
| Inpatient Hospital Care | In-Network: Days 1-6: $300.00 per day, per admission / Days 7-90: $0.00 per day, per admission Out-of-Network: 50% coinsurance per stay |
| Urgent Care | Urgent Care: $25.00 copay |
| Emergency Room Visit | Emergency Care: $125.00 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 per year. |
| Ambulance Transportation | Ground Ambulance: $275.00 copay Per Trip Air Ambulance: $275.00 copay |
Health Care Services and Medical Supplies
Anthem 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: $20.00 copay Out-of-Network: Medicare Covered Chiropractic Services: 50% coinsurance |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: $0.00 copay Out-of-Network: 50% coinsurance |
| Durable Medical Eqipment (DME) | In-Network: 20% coinsurance Out-of-Network: 50% coinsurance |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay - $15.00 copay X-Rays: $0.00 copay - $100.00 copay Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - $100.00 copay Diagnostic Radiological Services: $0.00 copay - $250.00 copay Out-of-Network: Lab Services: 50% coinsurance X-Rays: 50% coinsurance Therapeutic Radiological Services: 50% coinsurance Outpatient Diagnostic Procedures/Tests: 50% coinsurance Diagnostic Radiological Services: 50% coinsurance |
| Home Health Care | In-Network: $0.00 copay Out-of-Network: 50% coinsurance |
| Mental Health Inpatient Care | In-Network: Days 1-6: $300.00 per day, per admission / Days 7-90: $0.00 per day, per admission Out-of-Network: 50% coinsurance per stay |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $0.00 copay Out-of-Network: 50% coinsurance |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $300.00 copay Observation Services: $300.00 copay Ambulatory Surgical Center: $250.00 copay Out-of-Network: Outpatient Hospital - Surgery: 50% coinsurance Observation Services: 50% coinsurance Ambulatory Surgical Center: 50% coinsurance |
| Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $0.00 copay Out-of-Network: 50% 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: 50% coinsurance Routine Foot Care: 50% coinsurance |
| Skilled Nursing Facility Care | In-Network: Days 1 - 20: $0.00 per day / Days 21 - 100: $214.00 per day Out-of-Network: 50% coinsurance per stay |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | This plan covers up to a $3,000 allowance for covered preventive and comprehensive dental services every year. In-Network: Medicare Covered Dental: $0.00 copay Preventive Dental Services: $0.00 copay Comprehensive Dental Services: $0.00 copay Out-of-Network: Medicare Covered Dental: 50% coinsurance Non-Medicare Preventive Dental Services: 20% coinsurance Non-Medicare Comprehensive Dental Services: 50% coinsurance |
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 maximum eye exam coverage amount. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay This plan covers up to $325 for eyeglasses or contact lenses every year. Out-of-Network: Medicare Covered Eye Exam: 50% coinsurance Routine Eye Exam: $0.00 copay Medicare Covered Eye Wear: $0.00 copay 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 maximum plan benefit every year. $300 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000 maximum plan benefit for prescribed hearing aids every year. Out-of-Network: Medicare Covered Hearing Exam: 50% coinsurance Routine Hearing Exam: 20% coinsurance 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: 50% coinsurance |
