Alterwood Advantage Choice (HMO)

To be eligible for Alterwood Advantage Choice, 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.

Monthly Premium$35
DeductibleNo Deductible
Maximum Out-of-Pocket (MOOP)$8,300
Primary Care Physician Visit$0 copay – no referrals required
Specialist Visit$35 copay – no referrals required
Preventive Services$0 copay
Telehealth$0 copay for eligible services
Inpatient Hospital StayDays 1 – 5: $290 copay per day
Days 6 – 90: $0 copay per day
Outpatient Hospital Facility$250 copay
Ambulatory Surgical Center$150 copay
Emergency Care$90 copay
Urgent Care$35 copay
Diagnostic Tests (Sleep study, Stress test)$0 copay
Lab Services$0 copay
Diagnostic Radiology (MRI, CT scan)$195 copay
Therapeutic Radiology (Radiation for Cancer)20% coinsurance
X-Rays$20 copay
Diabetic Supplies0% - 20% coinsurance
Durable Medical Equipment20% coinsurance

Additional BenefitsDescription
DentalMedicare-covered: $40 copay

Preventive & Comprehensive Coverage: $2,000 annual allowance towards services.
Preventive services: $0 copay
Comprehensive services: 20% coinsurance
VisionMedicare-Covered Exam: $40 copay
Medicare-Covered Eyewear: 20% coinsurance
Routine Exam: $0 copay, 1 per year
$150 annual allowance towards eyewear
HearingMedicare-covered: $40 copay
Routine Exam: $0 copay, 1 per year
Hearing Aids: $475 - $1,950 copay per hearing aid, available annually
Transportation$0 copay, 10 one-way trips
Over-the-Counter (OTC) Products & Essential Food Pantry Items$35 quarterly allowance through plan’s catalog
Podiatry ServicesMedicare-Covered: $35 copay
Routine Care: $35 copay, 4 per year
Health & Wellness Program$150 annual reimbursement towards the purchase of a fitness tracker, at-home fitness equipment, participation in instructional fitness class, or gym membership
Home Delivered Meals14 healthy meals available after discharge from an inpatient hospital stay or skilled nursing facility stay, available 8 times per year
Chiropractic ServicesMedicare-Covered: $20 copay
Routine Care: $20 copay, 4 per year
Chiropractic Evaluation: $0 copay, 1 per year

Prescription CoverageStandard Retail & Mail Order Cost-Shares
DeductibleNo Deductible
30-day Supply90-day Supply
Tier 1 – Preferred Generics$3 copay$0 copay
Tier 2 – Generics$8 copay$8 copay
Tier 3 – Preferred Brands$47 copay$94 copay
Tier 4 – Non-Preferred Drugs$100 copay$300 copay
Tier 5 – Specialty33% coinsuranceNot Covered
Part D VaccinesOur plan covers most Part D vaccines at no cost to members.
InsulinMembers won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.

Plan Documents

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