Anthem Dual Advantage (HMO D-SNP) Medicare Special Need Plan H2628-005 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7100.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $325.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 14,623 beneficiaries
Introduction
CMS Plan ID H2628-005 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 $0.00 monthly premium, $0.00 medical deductible, and $7100.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $325.00.
Enrollment across the plan's service areas totals 14,623 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
Anthem Dual Advantage is a Medicare D-SNP plan for people who qualify for both 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.
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 H2628-005.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 or $30-$435 copay | In-network: $0 or $30-$435 copay |
| Lab services | In-network: $0 copay | In-network: $0 copay |
| Outpatient x-rays | In-network: $0 or $50 copay | In-network: $0 or $50 copay |
| Diagnostic tests and procedures | In-network: $0 or $0-$30 copay | In-network: $0 or $0-$30 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 or $130 copay | $0 or $130 copay |
| Worldwide emergency care | Coming soon | $0 copay |
| Urgent care | $0 or $20 copay | $0 or $20 copay |
| Inpatient hospital care | Tier 1 $0 or $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
Tier 1 $0 or $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $0 or $221 per day for days 21-100 |
Tier 1 $0 per day for days 1-20 $0 or $218 per day for days 21-100 |
| Ground ambulance | In-network: $0 or $260 copay | In-network: $0 or $260 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
| Outpatient group therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
| Inpatient psychiatric hospital care | Tier 1 $0 or $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
Tier 1 $0 or $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
| Occupational therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 0% or 20% coinsurance | In-network: 0% or 0%-20% coinsurance |
| Prosthetics | In-network: 0% or 20% coinsurance | In-network: 0% or 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0% or 0%-20% coinsurance | In-network: 0% or 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0% or 0%-20% coinsurance | In-network: 0% or 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | In-network: $0 copay | In-network: $0 copay |
| Endodontics | In-network: $0 copay | In-network: $0 copay |
| Restorative services | In-network: $0 copay | In-network: $0 copay |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | 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. |
In-network: $0 copay |
| 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. |
In-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay | 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: | ($2.60) |
| Supplemental Part D Premium: | $2.60 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $325.00 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 | 29% coinsurance | 25% coinsurance |
| Select Care Drugs | Not available | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2628)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| 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)668-2174
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-2193
- 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.
Plan Availability
Anthem Dual Advantage (H2628-005-0) is available in the following locations (click to open):
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) | http://www.anthem.com/shop | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding 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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