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 - $37 Premium may be reduced if you receive “Extra Help” or through the Maryland Senior Prescription Drug Assistance Program (SPDAP). |
| Medicaid Eligibility | Full 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 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 & Labs | $0 copay |
| X-Rays | $0 copay |
| Diabetic Supplies, Shoes, & Inserts | $0 copay |
| Durable Medical Equipment | $0 copay |
| Additional Benefits | Description |
|---|---|
| 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 |
| Vision | Routine Exam: $0 copay, 1 per year $400 allowance every 2 years towards eyewear |
| Hearing | 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 | $100 quarterly allowance through plan’s catalog |
| Podiatry Services | Medicare-Covered: $0 copay Routine Care: $0 copay, 6 per year |
| Chiropractic Services | Medicare-Covered: $0 copay Routine Care: $0 copay, 4 per year Chiropractic Evaluation: $0 copay, 1 per year |
| Prescription Coverage | Description | |
|---|---|---|
| Deductible | $0 – No Deductible | |
| 30-day Supply | 90-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) | ||