Alterwood Advantage Choice Plus (HMO)

To be eligible for Alterwood Advantage Choice Plus, you must have Medicare Part A and Part B and reside within one of the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s, Somerset, Talbot, Washington, Wicomico, and Worcester.

BenefitsDescription
Monthly Premium$125
Premium may be reduced if you receive “Extra Help” or through the Maryland Senior Prescription Drug Assistance Program (SPDAP).
Deductible$0 – No Deductible
Maximum Out-of-Pocket (MOOP)$7,550
Primary Care Physician Visit$0 copay – no referrals required
Specialist Visit$20 copay – no referrals required
Preventive Services$0 copay
Telehealth$0 copay for eligible services
Inpatient Hospital Stay$350 copay per stay
Outpatient Hospital Facility$150 copay
Ambulatory Surgical Center$100 copay
Emergency Care$90 copay
Urgent Care$20 copay
Diagnostic Tests & Labs$0 copay
X-Rays$10 copay
Diabetic Supplies, Shoes, & Inserts0% - 20% coinsurance
Durable Medical Equipment20% coinsurance

Additional BenefitsDescription
Preventive Dental$0 copay per visit & $2,000 annual allowance for all dental services
Comprehensive Dental20% coinsurance per visit & $2,000 annual allowance for all dental services
VisionRoutine Exam: $0 copay, 1 per year
$250 allowance every 2 years towards eyewear
HearingRoutine Exam: $0 copay, 1 per year
Hearing Aids: $475 - $1,950 copay per hearing aid
Lifestyle Medication$10 copay per month supply for generic erectile dysfunction medication
Podiatry ServicesMedicare-Covered: $40 copay
Routine Care: $0 copay, 4 per year
Chiropractic ServicesMedicare-Covered: $20 copay
Routine Care: $20 copay, 4 per year
Chiropractic Evaluation: $0 copay, 1 per year

Prescription CoverageDescription
Deductible$0 – No Deductible
30-day Supply90-day Supply
Tier 1 – Preferred Generics$0 copay$0 copay
Tier 2 – Generics$0 copay$0 copay
Tier 3 – Preferred Brands$47 copay$94 copay
Tier 4 – Non-Preferred Drugs$100 copay$300 copay
Tier 5 – Specialty33% coinsuranceNot Covered

Plan Documents

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