To be eligible for Alterwood Advantage Dual Secure, you must have Medicare Part A and Part B, have Medicaid through the State of Maryland, and reside within one of the following Maryland counties: Anne Arundel, Baltimore, Caroline, Carroll, Cecil, Charles, Dorchester, Harford, Howard, Kent, Montgomery, Queen Anne’s, Somerset, Talbot, Washington, Wicomico, and Worcester.
Benefits | Description |
---|---|
Monthly Premium | $0 |
Medicaid Eligibility | Full Benefit Dual Eligible (FBDE) Qualified Medicare Beneficiary (QMB) |
Deductible | No Deductible |
Maximum Out-of-Pocket (MOOP) | $8,300 |
Primary Care Physician Visit | $0 copay – no referrals required |
Specialist Visit | $0 copay – no referrals required |
Preventive Services | $0 copay |
Telehealth | $0 copay for eligible services |
Inpatient Hospital Stay | Days 1 – 6: $0 copay per day Days 7 – 90: $0 copay per day |
Outpatient Hospital Facility | $0 copay |
Ambulatory Surgical Center | $0 copay |
Emergency Care | $0 copay |
Urgent Care | $0 copay |
Diagnostic Tests (Sleep study, Stress test) | $0 copay |
Lab Services | $0 copay |
Diagnostic Radiology (MRI, CT scan) | $0 copay |
Therapeutic Radiology (Radiation for Cancer) | $0 copay |
X-Rays | $0 copay |
Diabetic Supplies | $0 copay |
Durable Medical Equipment | $0 copay |
Additional Benefits | Description |
---|---|
Dental | Medicare-covered: $0 copay Preventive & Comprehensive Coverage: $2,500 annual allowance towards services. Preventive services: $0 copay Comprehensive services: $0 copay |
Vision | Medicare-Covered Exam: $0 copay Medicare-Covered Eyewear: $0 copay Routine Exam: $0 copay, 1 per year $400 allowance every 2 years towards eyewear |
Hearing | Medicare-covered: $0 copay Routine Exam: $0 copay, 1 per year Hearing Aids: $1,350 allowance every 3 years |
Transportation | $0 copay, 36 one-way trips |
Over-the-Counter (OTC) Products & Essential Food Pantry Items | $150 quarterly allowance through plan’s catalog |
Utility Flex Card | $50 per month towards utilities such as gas, electric, and water This benefit is a part of a special supplemental program. All members may not qualify. |
Podiatry Services | Medicare-Covered: $0 copay Routine Care: $0 copay, 6 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 Meals | 14 healthy meals available after discharge from an inpatient hospital stay or skilled nursing facility stay, available 8 times per year |
Chiropractic Services | Medicare-Covered: $0 copay Routine Care: $0 copay, 4 per year Chiropractic Evaluation: $0 copay, 1 per year |
Prescription Coverage | Standard Retail & Mail Order Cost-Shares | |
---|---|---|
Deductible | $0 – No Deductible | |
30-day Supply | 90-day Supply | |
Generics | $0, $1.45, or $4.15 | $0, $1.45, or $4.15 |
(Depending on your level of Extra Help) | ||
All Other Drugs | $0, $4.30, $10.35 | $0, $4.30, $10.35 |
(Depending on your level of Extra Help) | ||
Part D Vaccines | Our plan covers most Part D vaccines at no cost to members. | |
Insulin | Members won’t pay more than $10.35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on. |