Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) Costs & Coverage, York County, Maine
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) Costs & Coverage, York County, Maine
Uncover the tailored benefits and costs of Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP), a 2025 Medicare Special Needs Plan crafted to support your specific healthcare req Dive into this detail page to see how this AMH Health SNP can support your specific health conditions or financial circumstances.
Available in York County, ME, to qualified beneficiaries, Anthem I MaineHealth Advantage Dual Plus offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
According to CMS enrollment data (May, 2025), there are approximately 7,790 members enrolled in this plan, 549 in York County.
Anthem I MaineHealth Advantage Dual Plus Overview
| Plan ID H9065-001-0 Overview | |
|---|---|
| Health Plan ID: | H9065-001-0 |
| Medicare Advantage Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9,350.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Basic, $590.00 deductible |
| Additional Benefits: | Vision, Hearing |
| Availability: | York County, ME |
| Insured By: | AMH Health |
What You Need to Know
- Anthem I MaineHealth Advantage Dual Plus is a HMO D-SNP health plan for dual-eligible (Medicare and Medicaid) beneficiaries.
- This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
- To qualify, you must have both Medicare Part A and Part B, you must live in the plan's service area (York County), and you must qualify for full Medicaid.
- It includes prescription drug coverage (Medicare Part D).
- The annual Part D deductible is $590.00.
- People who qualify for Medicare "Extra Help," can get additional assistance to help pay their Medicare Part D monthly premium, deductible, and copayments.
- The plan offers the same health insurance benefits as Original Medicare and some additional benefits that Original Medicare does not cover.
- If you don't qualify to join Anthem I MaineHealth Advantage Dual Plus , you might want to compare Medicare Advantage plans available in York County, Maine. Another popular option is to add one of the many Medicare supplements available in Maine and a stand-alone prescription drug plan.
- 2024 costs and benefits for Anthem I MaineHealth Advantage Dual Plus will be available in early October. Get Notification.
| We're Here to Help You Enroll |
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Costs such as premiums, deductibles, and copays vary greatly across different plans. Be sure to evaluate these expenses in detail to ensure they fit your individual financial and healthcare requirements.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $0 Copay |
| Inpatient hospital care: | Coming Soon |
| Skilled Nursing Facility: | Unknown |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required |
| Routine Foot Care: | $0 Copay Prior Authorization Required |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay Prior Authorization Required |
| Routine chiropractic: | $0 Copay Prior Authorization Required |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | Coming Soon |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Prior Authorization Required |
| Occupational therapy: | $0 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | $0 Copay |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $0 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $0 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | $0 Copay |
| Other Part B drugs (Medicare-covered): | $0 Copay |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $300.00 Every year |
Certain preventive services are covered 100% by Anthem I MaineHealth Advantage Dual Plus as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $11.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $11.20 |
| Low Income Premium Subsidy: | $33.77 |
| Low Income Premium Subsidy CMS Pays: | $11.20 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before AMH Health begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Anthem I MaineHealth Advantage Dual Plus has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *Deductible does not apply. | ||
The total monthly premium for Anthem I MaineHealth Advantage Dual Plus in York County is $0.00, which also covers your prescription drugs. Remember, you’ll still need to pay your monthly Medicare Part B premium.
CMS Star Ratings for Plan H9065-001-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
The annual health plan deductible for Anthem I MaineHealth Advantage Dual Plus is $0.00. Keep in mind, this excludes any deductible for the prescription drug plan, which is listed separately below.
The Maximum Out-of-Pocket (MOOP) with this AMH Health plan is {plan_moop}. Unlike Original Medicare, Medicare Advantage plans are required to set an annual MOOP limit for inpatient and outpatient care. After reaching this spending cap on copayments, all your Medicare Part A and Part B services will be covered in full for the rest of the year. Remember, MOOP does not include monthly premiums, prescription costs, or any extra benefits.
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage HMO D-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this AMH Health plan.
Here are some of the most frequently asked questions people have about plan ID H9065-001-0:
Anthem I MaineHealth Advantage Dual Plus is a Health Maintenance Organization (HMO) plan. As an HMO member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Anthem I MaineHealth Advantage Dual Plus does cover out-of-network care for emergencies and out-of-area dialysis.
[partd_coverage] [/partd_coverage]SNP Plan Enrollment Periods
Once you’ve confirmed your eligibility for Anthem I MaineHealth Advantage Dual Plus , it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
Contact AMH Health
| Contact Type | Details |
|---|---|
| Website: | AMH Health Plan Page |
| Providers: | AMH Health Providers Page |
| Formulary: | AMH Health Formulary Page |
| Pharmacy: | AMH Health Pharmacy Page |
| New Member Health Plan Help: | (833)668-2366 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2371 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- AMH Health, https://shop.anthem.com/medicare, Last Accessed June 1, 2025
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
Medicare Advantage and Part D plans and benefits offered by: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.