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.

BenefitsDescription
Monthly Premium$0 - $37
Premium may be reduced if you receive “Extra Help” or through the Maryland Senior Prescription Drug Assistance Program (SPDAP).
Medicaid EligibilityFull Benefit Dual Eligible (FBDE)
Qualified Medicare Beneficiary (QMB)
Deductible$0 – No Deductible
Maximum Out-of-Pocket (MOOP)$7,550
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 & Labs$0 copay
X-Rays$0 copay
Diabetic Supplies, Shoes, & Inserts$0 copay
Durable Medical Equipment$0 copay

Additional BenefitsDescription
Preventive Dental$0 copay per visit & $2,500 annual allowance for all dental services
Comprehensive Dental$0 copay per visit & $2,500 annual allowance for all dental services
VisionRoutine Exam: $0 copay, 1 per year
$400 allowance every 2 years towards eyewear
HearingRoutine 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$100 quarterly allowance through plan’s catalog
Podiatry ServicesMedicare-Covered: $0 copay
Routine Care: $0 copay, 6 per year
Chiropractic ServicesMedicare-Covered: $0 copay
Routine Care: $0 copay, 4 per year
Chiropractic Evaluation: $0 copay, 1 per year

Prescription CoverageDescription
Deductible$0 – No Deductible
30-day Supply90-day Supply
Generics$0, $1.35, or $3.95$0, $1.35, or $3.95
(Depending on your level of Extra Help)
All Other Drugs$0, $4.00, $9.85$0, $4.00, $9.85
(Depending on your level of Extra Help)

Plan Documents

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