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Alterwood Advantage Choice Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alterwood Advantage Choice Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alterwood Advantage Choice Plus (HMO) in 2025, please refer to our full plan details page.
Alterwood Advantage Choice Plus (HMO) is a HMO plan offered by LifeBridge Health, Inc. available for enrollment in 2025 to people living in Select Maryland Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Alterwood Advantage Choice Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alterwood Advantage Choice Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Alterwood Advantage Choice Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $122.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Alterwood Advantage Choice Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, standard generic drugs have a $47 copay, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $5.80 for each prescription during the Part D phase.
Additional Benefits
The Alterwood Advantage Choice Plus (HMO) plan offers a range of benefits, including inpatient hospital stays with a $325 copay per admission, and outpatient services with varying copays. You'll find no copays for primary care visits, preventive services, and home health services. The plan provides coverage for hearing, vision, and dental services, with copays or coinsurance depending on the specific service. Additionally, it covers emergency services, ambulance services, and various therapies, each with its own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $325 per admission or stay. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered. Outpatient hospital services have a $195 copay, observation services have a $100 copay, and ambulatory surgical center services have a $95 copay. Outpatient substance abuse services are covered with a $30 copay for individual sessions and a $20 copay for group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alterwood Advantage Choice Plus (HMO) plan. The plan has a $55 copay for this benefit.
Ambulance and Transportation Services See details
Under the Alterwood Advantage Choice Plus (HMO) plan, both ground and air ambulance services are covered, with a copay of $240 and $300, respectively, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Alterwood Advantage Choice Plus (HMO) plan, with a $110 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance, while Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Alterwood Advantage Choice Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with no copay, mental health specialty services with a copay of $30 for individual sessions and $20 for group sessions, podiatry services with a copay of $35 for routine foot care, other health care professional services with a copay between $0 and $20, psychiatric services with a copay of $30 for individual sessions and $20 for group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $35 copay. The plan also covers routine chiropractic care for 4 visits per year, and other chiropractic services, including a chiropractic evaluation, for 1 visit per year.
Preventive Services See details
The Alterwood Advantage Choice Plus (HMO) plan covers Medicare-covered preventive services with no copay, and additional preventive services. The plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services. The plan also covers fitness benefits, re-admission prevention, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services with the Alterwood Advantage Choice Plus (HMO) plan include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $475 and $1950. However, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $40 copay, and eyewear with 20% coinsurance. Routine eye exams have no copay, and eyewear has a combined maximum plan benefit coverage of $275 every two years.
Dental Services See details
Dental Services are covered by the Alterwood Advantage Choice Plus (HMO) plan, with a $40 copay for Medicare Dental Services. Other Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery, all with 20% coinsurance, while maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Alterwood Advantage Choice Plus (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alterwood Advantage Choice Plus (HMO) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Alterwood Advantage Choice Plus (HMO) plan. Durable Medical Equipment has a 20% coinsurance. Medical Supplies and Prosthetic Devices have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, and outpatient X-ray services with a $10 copay. Therapeutic Radiological Services have a coinsurance of at most 20%, and Diagnostic Radiological Services have a copay of at most $150.
Home Health Services See details
Home Health Services are covered by the Alterwood Advantage Choice Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice because none of the sub-services are covered. The plan does not specify any cost sharing information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alterwood Advantage Choice Plus (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with coverage including nicotine replacement therapy and Naloxone, and a meal benefit, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. There is no copay or coinsurance for the covered services.
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