Anthem Dual Advantage (HMO D-SNP) H0629-002 • 2027 • Elkhart County, IN
- Monthly Premium
- $14.20Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Elkhart County, IN
- Local Enrollment
- 282 beneficiaries in Elkhart County
Introduction
CMS Plan ID H0629-002 identifies Anthem Dual Advantage, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Anthem Blue Cross and Blue Shield. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $14.20 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment in this plan requires you to live in Elkhart County, Indiana. CMS reports 282 beneficiaries enrolled in this plan in Elkhart County. New members can call the plan directly at (833)668-2410 (TTY 711) for assistance.
Eligibility
Anthem Dual Advantage is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Elkhart County
Compare this plan with the two most-enrolled HMO D-SNP plans available in Elkhart County, Indiana. Enrollment is based on CMS local enrollment data.
| Plan Detail | Anthem Dual Advantage | Anthem I PathWays Dual Care Advantage | Anthem Full Dual Advantage |
|---|---|---|---|
| CMS Plan ID | H0629-002-0 |
H0629-003-0 |
H0629-001-0 |
| Local Enrollment | 282 | 267 | 185 |
| Monthly Premium | $14.20 | $9.20 | $1.70 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,850.00 | $9,850.00 | $9,850.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | 0% or 20% coinsurance | $0 copay | $0 copay |
| Specialist | 0% or 20% coinsurance | $0 copay | $0 copay |
| Part D Deductible | $700.00 | $615.00 | $475.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Anthem Dual Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0629-002.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0629-002-0 Cost Compare.
Office Visits
- Primary care
- In-network: 0% or 20% coinsurance
- Specialist
- In-network: 0% or 20% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 0% or 20% coinsurance
- Lab services
- In-network: 0% or 20% coinsurance
- Outpatient x-rays
- In-network: 0% or 20% coinsurance
- Diagnostic tests and procedures
- In-network: 0% or 20% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $0 or $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 or $20 copay
- Inpatient hospital care
- Tier 1
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150 - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$0 or $217 per day for days 21-100 - Ground ambulance
- In-network: 0% or 20% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 0% or 20% coinsurance
- Outpatient group therapy
- In-network: 0% or 20% coinsurance
- Inpatient psychiatric hospital care
- Tier 1
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 0% or 20% coinsurance
- Occupational therapy
- In-network: 0% or 20% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 0% or 20% coinsurance
- Prosthetics
- In-network: 0% or 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0% or 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0% or 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both. - OTC hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both.
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: $0 copay
Certain preventive services are covered 100% by Anthem Dual Advantage as a Part B benefit.
Prescription Drug Coverage
Anthem Dual Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $14.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $14.20 |
| Low-Income Premium Subsidy: | $17.02 |
| Low-Income Premium Subsidy Paid by CMS: | $14.20 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Anthem Blue Cross and Blue Shield starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Anthem Dual Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | 25% coinsurance | 25% coinsurance |
| Preferred Brand | 25% coinsurance | 25% coinsurance |
| Non-Preferred Drug | 25% coinsurance | 25% coinsurance |
| Specialty Tier | 25% coinsurance | 25% coinsurance |
| Select Care Drugs | Not available | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0629)
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | Plan too new to be measured |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for Anthem Blue Cross and Blue Shield
- Website
- Anthem Blue Cross and Blue Shield Plan Page
- Providers
- Anthem Blue Cross and Blue Shield Providers Page
- Formulary
- Anthem Blue Cross and Blue Shield Formulary Page
- Pharmacy
- Anthem Blue Cross and Blue Shield Pharmacy Page
- New Member Health Plan Help
- (833)668-2410
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-2409
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Anthem Blue Cross and Blue Shield (official source) | https://shop.anthem.com/medica | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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