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Anthem Dual Advantage (HMO D-SNP) Costs & Coverage — Rockbridge County, Virginia

CMS Rating:☆☆☆☆☆(0.0 out of 5 stars*)

Anthem Dual Advantage (HMO D-SNP) is a Dual-Eligible Medicare Special Needs Plan identified by CMS Plan-ID H4694-002-0 offered by Anthem HealthKeepers for the 2026 plan year.

The most recent CMS enrollment data shows an estimated 8,434 beneficiaries enrolled in this plan, with 38 in Rockbridge County.

Last update:

Anthem Dual Advantage Overview

2026 Medicare Special Needs Plan Overview for H4694-002-0
Plan Overview for H4694-002-0
CMS Plan ID: H4694-002-0
Plan Type: HMO D-SNP
Plan Year: 2026
Monthly Premium: $0.00
Plus your Medicare Part B premium.
Medical Deductible: $0.00
Maximum Out-of-Pocket: $9250.00 (In-Network)
Part B Give Back: Not offered
Prescription Drug Coverage: Enhanced, $605.00 deductible
Additional Benefits: Dental, Vision, Hearing
Service Area: Rockbridge County, VA
Enrollment (Nationwide): 8,434 beneficiaries
Enrollment (CMS – Local)38 beneficiaries in Rockbridge County
Provided By: Anthem HealthKeepers
If you qualify for Original Medicare and a Medicare Advantage Plan but don't know where to begin, our HealthCompare licensed insurance agents[1] are available at 1-833-748-3201 (TTY 711) to answer your questions (M-F 8AM-10PM, Sat 9AM-8PM EST) and help you enroll. There's no obligation.

To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).

Medicare Plan Decision Resources

Eligibility and Plan Network

Eligibility Requirements

Anthem Dual Advantage is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).

Eligibility requirements for Anthem Dual Advantage (H4694-002-0)
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: Prescription drug coverage (Part D) is included.

Plan Network

This plan uses a Health Maintenance Organization (HMO) network, meaning covered services are primarily provided by in-network doctors and facilities. Referrals are typically required for specialist care. Emergency services and out-of-area dialysis are covered outside the network.

CMS 5-Star Rating Marks

Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO D-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Anthem HealthKeepers plan.

2026 Medicare Star Ratings for Contract H4694
CMS Measure Star Rating
2026 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 ☆☆☆☆☆
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

Covered Services & Costs

Office Visits

This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.

Primary care and specialist visit costs for this plan.
Covered Service In-Network Cost
Primary: In-network: $0 copay | Out-of-network: $0 copay
Specialist: In-network: $0 copay | Out-of-network: $0 copay

Preventive and Wellness Services

Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.

Preventive and wellness service costs and benefits for this plan.
Covered Service In-Network Cost
Annual wellness exam: In-network: $0 copay
Telehealth benefit: In-network: $0 copay
Routine chiropractic: Not covered
Fitness benefits: In-network: $0 copay
Health education: Not covered
Counseling services: Not covered
Over-the-counter drug benefits: In-network: $0 copay
Health transportation (non-emergency): In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.

Diagnostic, laboratory, and imaging service costs for this plan.
Covered Service In-Network Cost
Diagnostic radiology services: In-network: $0 copay | Out-of-network: $0 copay
Lab services: In-network: $0 copay | Out-of-network: $0 copay
Outpatient x-rays: In-network: $0 copay | Out-of-network: $0 copay
Diagnostic tests and procedures: In-network: $0 copay | Out-of-network: $0 copay

Emergency and Urgent Care Services

Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.

Emergency, urgent care, hospital, ambulance, and skilled nursing costs for this plan.
Covered Service In-Network Cost
Emergency room care: $0 copay
Worldwide emergency care: $0 copay
Urgent care: $0 copay
Inpatient hospital care: Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150
Skilled Nursing Facility: Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100
Ground ambulance: In-network: $0 copay | Out-of-network: $0 copay

Mental Health Services

Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.

Mental health therapy and inpatient psychiatric care costs for this plan.
Covered Service In-Network Cost
Outpatient individual therapy: In-network: $0 copay | Out-of-network: $0 copay
Outpatient group therapy: In-network: $0 copay | Out-of-network: $0 copay
Inpatient psychiatric hospital care: Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150

Rehabilitation Services

Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.

Physical, speech, and occupational therapy costs for this plan.
Covered Service In-Network Cost
Physical therapy and speech and language therapy: In-network: $0 copay | Out-of-network: $0 copay
Occupational therapy: In-network: $0 copay | Out-of-network: $0 copay

Medical Equipment and Supplies

Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.

Diabetes supplies, durable medical equipment, and prosthetic costs for this plan.
Covered Service In-Network Cost
Diabetes supplies: In-network: $0 copay | Out-of-network: $0 copay
Durable medical equipment: In-network: $0 copay | Out-of-network: $0 copay
Prosthetics: In-network: $0 copay | Out-of-network: $0 copay

Medicare Part B Drugs

Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.

Chemotherapy and other Medicare Part B-covered drug costs for this plan.
Covered Service In-Network Cost
Chemotherapy: In-network: $0 copay | Out-of-network: $0 copay
Other Part B drugs (Medicare-covered): In-network: $0 copay | Out-of-network: $0 copay

Dental Services

Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.

Preventive and comprehensive dental service costs for this plan.
Covered Service In-Network Cost
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

Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.

Routine eye exams, contact lenses, and eyewear costs for this plan.
Covered Service In-Network Cost
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 coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.

Hearing exams, fittings, and hearing aid costs for this plan.
Covered Service In-Network Cost
Hearing exam: In-network: $0 copay
Fitting/evaluation: In-network: $0 copay
Prescription hearing aids: In-network: $0 copay
OTC hearing aids: In-network: $0 copay

Additional and Special Needs Services

Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.

Additional and special needs service costs and benefits for this plan.
Covered Service In-Network Cost
Adult day health services: Not covered
Home-based palliative care: Not covered
Personal emergency response system: In-network: $0 copay
Weight management programs: Not covered
Wigs for chemotherapy-related hair loss: Not covered
Alternative therapies: Not covered
Massage therapy: Not covered
Home/bathroom safety devices: In-network: $0 copay

Anthem Dual Advantage covers 100% of certain preventive services as a required Part B benefit.

Prescription Drug Coverage

Part D Coverage Level (Benefit Design)

Anthem Dual Advantage includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.

Plan Premium

The following table outlines the prescription drug plan premium details of this plan.

Medicare Part D Premium Breakdown for Anthem Dual Advantage (HMO D-SNP)
Part D Premium Component Amount
Basic Part D Premium: $-4.70
Supplemental Part D Premium: $4.70
Total Part D Premium: $0.00
Low Income Premium Subsidy: $24.56
Low Income Premium Subsidy CMS Pays: $0.00
Low Income Subsidy Premium: $0.00

For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.

Plan Deductible

The Medicare Part D annual deductible with this plan is $605.00. This is the amount you must pay at the pharmacy before Anthem HealthKeepers begins paying its share.

Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Anthem Dual Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.

Prescription Drug Tier Pricing for Anthem Dual Advantage (HMO D-SNP)
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic25% coinsuranceComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug25% coinsuranceComing soon
Specialty Tier25% coinsuranceComing soon
Select Care Drugs$0.00 copayComing soon
*Deductible does not apply.

Contact Anthem HealthKeepers

Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .

Anthem HealthKeepers Plan Contact Details for Anthem Dual Advantage (HMO D-SNP)
Contact Type Details
Website: Anthem HealthKeepers Plan Page
New Members: 1-833-668-1732
Existing Members: 1-833-824-1393
Plan Address: P.O. Box 659404 | San Antonio, TX 78265
Medicare Plan Data Sources and Methodology
Primary CMS datasets used to compile information about Plan ID H4694-002-0
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services 202608
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2026
Plan Benefits Package Centers for Medicare & Medicaid Services 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-08
Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Anthem HealthKeepers (official source) https://shop.anthem.com/medicare October 13, 2025
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) September 20, 2025
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage 5 May, 2025

Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.

Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.