Alterwood Advantage Dual Secure (HMO D-SNP)

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.

Monthly Premium$0
Medicaid EligibilityFull Benefit Dual Eligible (FBDE)
Qualified Medicare Beneficiary (QMB)
DeductibleNo 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 StayDays 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 BenefitsDescription
DentalMedicare-covered: $0 copay

Preventive & Comprehensive Coverage: $2,500 annual allowance towards services.
Preventive services: $0 copay
Comprehensive services: $0 copay
VisionMedicare-Covered Exam: $0 copay
Medicare-Covered Eyewear: $0 copay
Routine Exam: $0 copay, 1 per year
$400 allowance every 2 years towards eyewear
HearingMedicare-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 ServicesMedicare-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 Meals14 healthy meals available after discharge from an inpatient hospital stay or skilled nursing facility stay, available 8 times per year
Chiropractic ServicesMedicare-Covered: $0 copay
Routine Care: $0 copay, 4 per year
Chiropractic Evaluation: $0 copay, 1 per year

Prescription CoverageStandard Retail & Mail Order Cost-Shares
Deductible$0 – No Deductible
30-day Supply90-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 VaccinesOur plan covers most Part D vaccines at no cost to members.
InsulinMembers 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.

Plan Documents

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