Anthem Full Dual Advantage (HMO D-SNP)
Available to residents of Staunton City County, VA for 2027. Contract H4694, plan 004, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Consolidated into another plan for 2027. CMS crosswalks 2026’s Anthem Full Dual Advantage 2 (HMO D-SNP) (H4694-001-0) into this plan, so its members move here unless they choose otherwise.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00 |
| In-network out-of-pocket maximum | $9,850.00 |
| Drug deductible | $105.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO D-SNP |
| Special needs plan | Dual-eligible SNP |
| D-SNP integration status | Highly Integrated (HIDE) |
| Zero-dollar cost sharing D-SNP | Yes |
| Contract / plan | H4694-004-0 |
| Offered by | Anthem HealthKeepers |
| Parent organization | Elevance Health, Inc. |
| Formulary tiers | 5 |
| Member services | (833)668-2165TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H4694 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 32% |
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Staying Healthy: Screenings, Tests and Vaccines | ||
| Breast Cancer Screening · C01 | 2 out of 5 stars for Breast Cancer Screening | too new |
| Colorectal Cancer Screening · C02 | 2 out of 5 stars for Colorectal Cancer Screening | too new |
| Annual Flu Vaccine · C03 | 2 out of 5 stars for Annual Flu Vaccine | too new |
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 3 out of 5 stars for Special Needs Plan (SNP) Care Management | too new |
| Care for Older Adults – Medication Review · C08 | 4 out of 5 stars for Care for Older Adults – Medication Review | too new |
| Care for Older Adults - Functional Status Assessment · C09 | 4 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Osteoporosis Management in Women who had a Fracture · C10 | 1 out of 5 stars for Osteoporosis Management in Women who had a Fracture | too new |
| Diabetes Care – Eye Exam · C11 | 2 out of 5 stars for Diabetes Care – Eye Exam | too new |
| Diabetes Care – Blood Sugar Controlled · C12 | 3 out of 5 stars for Diabetes Care – Blood Sugar Controlled | too new |
| Kidney Health Evaluation for Patients with Diabetes · C13 | 2 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes | too new |
| Controlling High Blood Pressure · C14 | 2 out of 5 stars for Controlling High Blood Pressure | too new |
| Plan All-Cause Readmissions · C17 | 2 out of 5 stars for Plan All-Cause Readmissions | too new |
| Statin Therapy for Patients with Cardiovascular Disease · C18 | 3 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease | too new |
| Transitions of Care · C19 | 4 out of 5 stars for Transitions of Care | too new |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20 | 2 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | too new |
| Member Experience with Health Plan | ||
| Getting Needed Care · C21 | 4 out of 5 stars for Getting Needed Care | too new |
| Getting Appointments and Care Quickly · C22 | 4 out of 5 stars for Getting Appointments and Care Quickly | too new |
| Customer Service · C23 | 3 out of 5 stars for Customer Service | too new |
| Rating of Health Care Quality · C24 | 3 out of 5 stars for Rating of Health Care Quality | too new |
| Rating of Health Plan · C25 | 4 out of 5 stars for Rating of Health Plan | too new |
| Member Complaints and Changes in the Health Plan's Performance | ||
| Complaints about the Health Plan · C27 | 4 out of 5 stars for Complaints about the Health Plan | too new |
| Members Choosing to Leave the Plan · C28 | 4 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| Health Plan Customer Service | ||
| Plan Makes Timely Decisions about Appeals · C30 | 5 out of 5 stars for Plan Makes Timely Decisions about Appeals | not enough data |
| Reviewing Appeals Decisions · C31 | 5 out of 5 stars for Reviewing Appeals Decisions | not enough data |
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Complaints about the Drug Plan · D02 | 4 out of 5 stars for Complaints about the Drug Plan | too new |
| Members Choosing to Leave the Plan · D03 | 4 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| DD3: Member Experience with the Drug Plan | ||
| Rating of Drug Plan · D05 | 4 out of 5 stars for Rating of Drug Plan | too new |
| Getting Needed Prescription Drugs · D06 | 4 out of 5 stars for Getting Needed Prescription Drugs | too new |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 4 out of 5 stars for MPF Price Accuracy | too new |
| Medication Adherence for Diabetes Medications · D08 | 2 out of 5 stars for Medication Adherence for Diabetes Medications | too new |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 3 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | too new |
| Medication Adherence for Cholesterol (Statins) · D10 | 3 out of 5 stars for Medication Adherence for Cholesterol (Statins) | too new |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 3 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | too new |
| Concurrent Use of Opioids and Benzodiazepines (COB) · D12 | 3 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB) | new measure |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13 | 2 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | new measure |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H4694 shares it.
Also available in 132 other VA counties
- Accomack
- Albemarle
- Alexandria City
- Alleghany
- Amelia
- Amherst
- Appomattox
- Arlington
- Augusta
- Bath
- Bedford
- Bland
- Botetourt
- Bristol City
- Brunswick
- Buchanan
- Buckingham
- Buena Vista City
- Campbell
- Caroline
- Carroll
- Charles City
- Charlotte
- Charlottesville City
- Chesapeake City
- Chesterfield
- Clarke
- Colonial Heights City
- Covington City
- Craig
- Culpeper
- Cumberland
- Danville City
- Dickenson
- Dinwiddie
- Emporia City
- Essex
- Fairfax City
- Fairfax
- Falls Church City
- Fauquier
- Floyd
- Fluvanna
- Franklin City
- Franklin
- Frederick
- Fredericksburg City
- Galax City
- Giles
- Gloucester
- Goochland
- Grayson
- Greene
- Greensville
- Halifax
- Hampton City
- Hanover
- Harrisonburg City
- Henrico
- Henry
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.