To be eligible for Alterwood Advantage Select, you must have Medicare Part A and Part B and reside
within one of the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline,
Carroll, Cecil, Charles, Dorchester, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s,
Somerset, Talbot, Washington, Wicomico, and Worcester.
| Benefits | Description | |
|---|---|---|
| Monthly Premium | $0 | |
| Deductible | $750 on select services | |
| Maximum Out-of-Pocket (MOOP) | $8,300 | |
| Primary Care Physician Visit | $0 copay – no referrals required | |
| Specialist Visit | $45 copay – no referrals required | |
| Preventive Services | $0 copay | |
| Telehealth | $0 copay for eligible services | |
| Inpatient Hospital Stay | Deductible, then: Days 1 – 3: $290 copay per day Days 4 – 90: $0 copay per day |
|
| Outpatient Hospital Facility | Deductible, then: $300 copay | |
| Ambulatory Surgical Center | $225 copay | |
| Emergency Care | $90 copay | |
| Urgent Care | $35 copay | |
| Diagnostic Tests (Sleep study, Stress test) | $15 copay | |
| Lab Services | $0 copay | |
| Diagnostic Radiology (MRI, CT scan) | Deductible, then: $195 copay | |
| Therapeutic Radiology (Radiation for Cancer) | Deductible, then: 20% coinsurance | |
| X-Rays | $20 copay | |
| Diabetic Supplies | 0% - 20% coinsurance | |
| Durable Medical Equipment | 20% coinsurance | |
| Additional Benefits | Description |
|---|---|
| Dental | Medicare-covered: $40 copay Preventive & Comprehensive Coverage: $2,000 annual allowance towards services. Preventive services: $0 copay Comprehensive services: 20% coinsurance |
| Vision | Medicare-Covered Exam: $40 copay Medicare-Covered Eyewear: 20% coinsurance Routine Exam: $0 copay, 1 per year $150 annual allowance towards eyewear |
| Hearing | Medicare-covered: $40 copay Routine Exam: $0 copay, 1 per year Hearing Aids: $475 - $1,950 copay per hearing aid, available annually |
| Transportation | $0 copay, 10 one-way trips |
| Over-the-Counter (OTC) Products & Essential Food Pantry Items | $35 quarterly allowance through plan’s catalog |
| Podiatry Services | Medicare-Covered: $35 copay Routine Care: $35 copay, 4 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: $20 copay Routine Care: $20 copay, 4 per year Chiropractic Evaluation: $0 copay, 1 per year |
| Prescription Coverage | Description | |
|---|---|---|
| Deductible | $295 on Tiers 3, 4, & 5 | |
| 30-day Supply | 90-day Supply | |
| Tier 1 – Preferred Generics | $3 copay | $0 copay |
| Tier 2 – Generics | $8 copay | $8 copay |
| Tier 3 – Preferred Brands | $47 copay | $94 copay |
| Tier 4 – Non-Preferred Drugs | $100 copay | $300 copay |
| Tier 5 – Specialty | 28% coinsurance | Not Covered |
| Part D Vaccines | Our plan covers most Part D vaccines at no cost to members, even if they haven't met their deductible. | |
| 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, even if the member hasn't met their deductible yet. | |