D-SNP Plan Costs & Benefits

Anthem l MaineHealth Advantage Dual Plus is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Anthem l MaineHealth Advantage Dual Plus does allow out-of-network care for emergencies and out-of-area dialysis.

Premiums, deductibles, and copays can widely vary between plans. It is important to compare costs and apply them to your personal financial and healthcare needs.

Healthcare Service	Member Cost
Health plan deductible	$0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,300 In-network
Doctor Visits
Specialist	$0 copay (authorization required)
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	$0 copay
Mental Health Services
Outpatient individual therapy visit	$0 copay (authorization required)
Outpatient group therapy visit with a psychiatrist	$0 copay (authorization required)
Inpatient hospital - psychiatric	$0 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist	$0 copay (authorization required)
Rehabilitation Services
Occupational therapy visit	$0 copay (authorization required)
Medical Equipment / Supplies
Prosthetics (e.g., braces, artificial limbs)	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen)	$0 copay (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Outpatient x-rays	$0 copay (authorization required)
Lab services	$0 copay (authorization required)
Diagnostic tests and procedures	$0 copay (authorization required)
Medicare Part B Drugs
Other Part B drugs	$0 copay (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment	$0 copay (authorization required)
Hearing
Hearing aids	$0 copay (authorization required, limits may apply)
Fitting/evaluation	$0 copay (authorization required, limits may apply)
Preventive Dental
Fluoride treatment	$0 copay
Oral exam	$0 copay (limits may apply)
Dental x-ray(s)	$0 copay (limits may apply)
Comprehensive Dental
Restorative services	$0 copay (authorization required, limits may apply)
Diagnostic services	$0 copay (authorization required, limits may apply)
Non-routine services	$0 copay (authorization required, limits may apply)
Periodontics	$0 copay (authorization required, limits may apply)
Endodontics	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (authorization required, limits may apply)
Vision
Contact lenses	$0 copay (limits may apply)
Eyeglass frames	$0 copay (limits may apply)
Eyeglass lenses	$0 copay (limits may apply)
Upgrades	$0 copay (limits may apply)
Routine eye exam	$0 copay (limits may apply)
Other	Not covered
Emergency Care / Urgent Care
Urgent care	$0 copay
Ground ambulance	$0 copay
Inpatient hospital coverage	$0 copay
Outpatient hospital coverage	$0 copay
Skilled Nursing Facility	$0 copay
Optional supplemental benefits	No

Prescription Costs & Benefits

The Part D benefits bundled with Anthem l MaineHealth Advantage Dual Plus is an enhanced benefit plan. Enhanced benefit Part D plans have a higher actuarial value than basic plans. This simply refers to the overall percentage of costs covered by the plan.

Prescription Drug Plan Premium

Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. 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 l MaineHealth Advantage Dual Plus has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

Medicare's 5-Star Rating Marks

The table below shows the quality ratings for this AMH Health plan. Each year Medicare rates Special Needs Plans using nine categories. We do not recommend joining a plan with an overall rating of less than 3 stars.

Do You Qualify to Join Anthem l MaineHealth Advantage Dual Plus?

Unfortunately, not everyone on Medicare will qualify to join Anthem l MaineHealth Advantage Dual Plus. To join a 2023 Medicare Special Needs Plan in Hancock County, Maine you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Maine Medicaid eligibility is based on your income and assets. Here are Maine's Medicaid thresholds.

Medicare beneficiaries who don't qualify to enroll in Anthem l MaineHealth Advantage Dual Plus, or another Special Needs Plan, are encouraged to look at Hancock County Medicare Advantage plans options.

Contact AMH Health

The Hancock County Medicare SNP plan information on this page originates from Medicare.gov. It was last updated on February 5, 2023.