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Anthem Full Dual Advantage (PPO D-SNP) - H4036-032-000

4 out of 5 stars* for plan year 2025

$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: H4036-032-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0.00

Monthly Premium

Georgia 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 Georgia 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

CoverageDetails
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$9,350.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$2,000.00
Primary care doctor visitIn-Network:
$0.00 copay
Specialty doctor visitIn-Network:
$0.00 copay
Inpatient hospital careIn-Network:
$0.00 copay per stay
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 per year.
Ambulance transportationGround Ambulance: $0.00 copay Per Trip
Air Ambulance: $0.00 copay

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).

CoverageDetails
Chiropractic services
Out-of-Network:
Medicare Covered Chiropractic Services: $0.00 copay - 40% coinsurance
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:
Diabetic Supplies: $0.00 copay
Durable medical equipment (DME)In-Network:
$0.00 copay
Diagnostic tests, lab and radiology services, and X-rays
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
Out-of-Network:
$0.00 copay
Mental health inpatient care
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
Out-of-Network:
$0.00 copay - 40% coinsurance
Outpatient services/surgeryIn-Network:
Outpatient Hospital - Surgery: $0.00 copay
Observation Services: $0.00 copay
Ambulatory Surgical Center: $0.00 copay
Outpatient substance abuse care
Out-of-Network:
$0.00 copay - 40% coinsurance
Podiatry servicesIn-Network:
Medicare Covered Podiatry Services: $0.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Skilled Nursing Facility (SNF) care
Out-of-Network:
Days 1-20: $0.00 per day, per admission / Days 21-100: $214.00 per day

Dental Benefits

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

CoverageDetails
Dental care
Out-of-Network:
Medicare Covered Dental: $0.00 copay - 40% coinsurance
Non-Medicare Preventive Dental Services: $0.00 copay
Non-Medicare Comprehensive Dental Services: $0.00 copay

Vision Benefits

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

CoverageDetails
Vision care
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.

CoverageDetails
Hearing careIn-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.

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.

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

When reviewing Georgia 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 Georgia 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

Georgia 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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