Anthem Full Dual Advantage (HMO D-SNP)

ANTHEM INSURANCE COMPANIES, INC. · 2027 plan year

Plan ID H0629-001-000

HMODual-Eligible SNP
MOOP (in-network)
$9,850
MOOP (combined)
—
Monthly premium
$1.70/mo
Part C $0 + Part D $1.70, before Extra Help
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H0629-001-000
Medical deductible
Medicare Part B deductible (CMS has not yet announced the 2027 amount)
Part D premium
$1.70/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$475/yr
Also owed
Your Medicare Part B premium, paid separately

More ANTHEM INSURANCE COMPANIES, INC. plans in IN

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — AcuteOriginal Medicare cost sharing
Inpatient Hospital — PsychiatricOriginal Medicare cost sharing
Worldwide Urgent Care CoverageNo charge

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions20% coinsurance
Mental Health — Group Sessions20% coinsurance
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions20% coinsurance
Medicare-Covered Preventive ServicesSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Skilled Nursing Facility (SNF)Original Medicare cost sharing
Intensive Cardiac Rehabilitation — Additional Sessions20% coinsurance
Pulmonary Rehabilitation — Additional Sessions20% coinsurance
Supervised Exercise Therapy (SET)20% coinsurance
Emergency Services$115
Urgently Needed Services$20
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency CoverageNo charge
Worldwide Emergency TransportationNo charge
Partial Hospitalization Program$115
Intensive Outpatient Program (IOP)$115
Home Health ServicesNo charge
Primary Care Physician Services20% coinsurance
Chiropractic Services20% coinsurance
Occupational Therapy Services20% coinsurance
Physician Specialist Services20% coinsurance
Podiatry Services20% coinsurance
Podiatry ServicesNo charge
Other Health Care Professional Services20% coinsurance
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions20% coinsurance
Psychiatric Services — Group Sessions20% coinsurance
Physical Therapy & Speech-Language Pathology20% coinsurance
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program Services20% coinsurance
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests20% coinsurance
Laboratory Services20% coinsurance
Radiological ServicesSee plan details
Diagnostic Radiology20% coinsurance
Therapeutic Radiology20% coinsurance
X-Ray Services20% coinsurance
Outpatient Hospital Services20% coinsurance
Hospital Observation Services20% coinsurance
Ambulatory Surgical Center (ASC)20% coinsurance
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions20% coinsurance
Substance Abuse — Group Sessions20% coinsurance
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance20% coinsurance
Air Ambulance20% coinsurance
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic Monitors20% coinsurance
Dialysis Services20% coinsurance
Over-the-Counter (OTC) ItemsNo charge
Meal BenefitNo charge
Annual Physical ExamNo charge
Fitness BenefitNo charge
Remote Access TechnologiesNo charge
Home & Bathroom Safety DevicesNo charge
Personal Emergency Response System (PERS)No charge
Kidney Disease Education ServicesNo charge
Glaucoma Screening20% coinsurance
Diabetes Self-Management Training20% coinsurance
Digital Rectal Exams20% coinsurance
Welcome to Medicare EKG20% coinsurance
Insulin (Part B)$35
Dental — Medicare-Covered Services20% coinsurance
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Periodontics (Gum Care)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Dental — Fixed Prosthodontics (Bridges)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye Exams20% coinsurance
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — Eyewear20% coinsurance
Vision — EyewearSee plan details
Vision — Eyeglass FramesNo charge
Hearing — Exams20% coinsurance
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge
Hearing — OTC Hearing AidsNo charge

Service area

  • IN: 92 counties

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