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Alterwood Advantage Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alterwood Advantage Choice (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 (HMO) in 2025, please refer to our full plan details page.
Alterwood Advantage Choice (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 (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 (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 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. The copay depends on the drug tier and the pharmacy you use. For example, you will pay an $8 copay for preferred generic drugs at a standard pharmacy or via mail order. You will pay 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Alterwood Advantage Choice (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $325 copay for the first six days, with no copay for days 7-90. Outpatient services have different copays, such as $325 for outpatient hospital services and $150 for ambulatory surgical center services. The plan covers primary care and many other services with no copay. Vision services include eye exams with a $40 copay and eyewear with 20% coinsurance. Dental services include coverage for Medicare Dental Services with a $40 copay, and other dental services with a $3,000 maximum benefit per year.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each requiring prior authorization. For days 1-6, the copay is $325, and for days 7-90, there is no copay. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a $325 copay, observation services have a $200 copay, and ASC services have a $150 copay. Individual outpatient substance abuse sessions have a copay between $30 and $30, and group sessions have a copay between $20 and $20.
Partial Hospitalization See details
Partial Hospitalization is covered under the Alterwood Advantage Choice (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $240 copay, and air ambulance services have a $300 copay, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for 10 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Alterwood Advantage Choice (HMO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
The Alterwood Advantage Choice (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Additionally, occupational therapy services have a $30 copay. Physician specialist services have a $20 copay, and physical therapy and speech-language pathology services have a $30 copay. Individual and group sessions for mental health have a minimum copay of $30 and $20 respectively. Podiatry services have a minimum copay of $35. Other Health Care Professional benefits have a minimum copay of $20. Psychiatric and Opioid Treatment Program Services have a minimum copay of $30 and $35 respectively.
Preventive Services See details
The Alterwood Advantage Choice (HMO) plan covers preventive services including Medicare-covered services, Kidney Disease Education Services, and other preventive services like Glaucoma Screenings and Diabetes Self-Management Training. Annual physical exams, health education, and several other services are not covered.
Hearing Services See details
The Alterwood Advantage Choice (HMO) plan covers 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 for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Alterwood Advantage Choice (HMO) plan covers vision services, including eye exams with a $40 copay and eyewear with 20% coinsurance and a combined maximum benefit of $150 per year. Routine eye exams have no copay, while upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $40 copay, and other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 20% coinsurance. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Alterwood Advantage Choice (HMO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Alterwood Advantage Choice (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
The Alterwood Advantage Choice (HMO) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $200, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Alterwood Advantage Choice (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alterwood Advantage Choice (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Alterwood Advantage Choice (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit. 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.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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