To be eligible for Alterwood Advantage Dual Value, 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, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s, Somerset, Talbot, Washington, Wicomico, and Worcester.
| 2027 Benefits | Description |
|---|---|
| Monthly Premium | $0 |
| Medicaid Eligibility | Full Benefit Dual Eligible (FBDE) Qualified Medicare Beneficiary (QMB) Specified Low-Income Medicare Beneficiary (SLMB) Qualified Individual (QI) Qualified Disabled Working Individual (QDWI) |
| Deductible | No Deductible |
| Maximum Out-of-Pocket (MOOP) | $9,250 |
| Primary Care Physician Visit | $0 copay – no referrals required |
| Specialist Visit | $20 copay – no referrals required |
| Preventive Services | $0 copay |
| Telehealth | $0 copay for eligible services |
| Inpatient Hospital Stay | Days 1 – 6: $320 - $405 copay per day Days 7 – 90: $0 copay per day |
| Outpatient Hospital Facility | $320 - $800 copay |
| Ambulatory Surgical Center | $50 copay |
| Emergency Care | $115 copay |
| Urgent Care | $0 copay |
| Lab Services | $0 copay |
| Diagnostic Radiology (MRI, CT scan) | $175 - $435 copay |
| Therapeutic Radiology (Radiation for Cancer) | 20% coinsurance |
| X-Rays | $15 -$40 copay |
| Physical Therapy | $20 copay |
| Home Health Care | $0 copay |
| Diabetic Supplies | 0% - 20% coinsurance |
| Durable Medical Equipment | 20% coinsurance |
| Additional Benefits | Description |
|---|---|
| Dental | Medicare-covered: $40 copay Preventive & Comprehensive Coverage: $1,695 combined annual allowance towards covered preventive and comprehensive services. Preventive services: $0 copay Comprehensive services: $0 copay |
| Vision | Medicare-Covered Exam: $40 copay Medicare-Covered Eyewear: 20% coinsurance Routine Exam: $0 copay, 1 per year $400 allowance every 2 years towards eyewear |
| Hearing | Medicare-covered: $40 copay Routine Exam: $0 copay, 1 per year Hearing Aids: $1,350 allowance every 3 years |
| Transportation | $0 copay, 22 one-way trips |
| Flex Card | $70 monthly allowance All members may use their monthly allowance towards the purchase of over-the-counter (OTC) products. Additionally, members with a qualifying chronic condition may also use their monthly allowance towards groceries, utilities, pest control, or housekeeping services. A portion of this benefit is a part of a special supplemental program. All members may not qualify. |
| Podiatry Services | Medicare-Covered: $25 copay Routine Care: $25 copay, 6 per year |
| Health & Wellness Program | $200 annual reimbursement towards the purchase of a fitness tracker, at-home fitness equipment, participation in instructional fitness class, or gym membership |
| Home Delivered Meals | 7 healthy meals available after discharge from an inpatient hospital stay or skilled nursing facility stay, available 8 times per year |
| Chiropractic Services | Medicare-Covered: $15 copay Routine Care: $15 copay, 4 per year Chiropractic Evaluation: $0 copay, 1 per year |
| Prescription Drug Coverage | Description - Retail Pharmacy | |
|---|---|---|
| Deductible | $505 on Tiers 3, 4, & 5 (If you are eligible for “Extra Help”, you most likely pay $0.) | |
| 1 Month Supply | 3 Month Supply | |
| Preferred Generics | $0 copay | $0 copay |
| Generics | 20% coinsurance* | 20% coinsurance* |
| Preferred Brands | 25% coinsurance* | 25% coinsurance* |
| Non-Preferred Drugs | 25% coinsurance* | 25% coinsurance* |
| Specialty | 28% coinsurance* | Not Covered |
| *You may pay less depending on your level of “Extra Help” you receive. | ||
| Part D Vaccines | Our plan covers most Part D vaccines at no cost to members. | |
| Insulin | Members 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. | |