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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 2026, 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 2026.
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 $7500.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately without any upfront out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order for one, two, or three-month supplies. Tier 2 generic medications are also highly affordable, costing a flat $8.00 copay for up to a three-month supply. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $47.00 copay for a one-month supply, while Tier 4 non-preferred drugs cost $100.00 per month. Multi-month supplies for Tiers 3 and 4 scale proportionally up to a three-month supply for both standard pharmacy and mail-order options. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply, with no multi-month supply options available.
Additional Benefits
The Alterwood Advantage Choice (HMO) plan offers robust medical coverage with predictable costs, featuring no copay for primary care visits and a $20 copay for specialists. If you require hospital care, inpatient stays carry a $325 daily copay for the first six days and no copay thereafter, with no coinsurance required. Emergency room visits have a $115 copay, while urgently needed care is available with no copay. Members also benefit from dental, vision, and hearing coverage, including no copay for routine exams and preventive dental care. The plan features a generous $3,600 annual dental limit, a $150 eyewear allowance, and covered over-the-counter items with no copay. Additionally, home health services and skilled nursing facility stays for the first 20 days are provided with no copay.
Inpatient Hospital See details
Alterwood Advantage Choice (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Alterwood Advantage Choice (HMO) with no coinsurance, featuring copays of $325 to $815 for outpatient hospital services, $200 to $500 per stay for observation services, and $50 for ambulatory surgical center services. Outpatient substance abuse services require a copay of $20 to $30 with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Alterwood Advantage Choice (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Alterwood Advantage Choice (HMO) covers ambulance services with no coinsurance and a copay of $240 for ground and $300 for air transport. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Alterwood Advantage Choice (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services are covered with no copay and no coinsurance. Worldwide emergency services, including emergency coverage, urgent coverage, and emergency transportation, are not covered.
Primary Care See details
Alterwood Advantage Choice (HMO) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits require a $20 copay, while other covered services—including physical therapy, chiropractic care, and mental health services—have copays ranging from $15 to $35, all with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Alterwood Advantage Choice (HMO) with no copay and no coinsurance for covered options like kidney disease education, diabetes self-management, and a $200 annual fitness benefit. Excluded sub-services that are not covered include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, alternative therapies, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Alterwood Advantage Choice (HMO) include Medicare-covered exams for a $40 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $475 to $1,950 for up to two aids per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Alterwood Advantage Choice (HMO), offering one annual routine eye exam with no copay or coinsurance, and other covered eye exams for a $40 copay and no coinsurance. Eyewear is covered up to a $150 annual limit with no copay and 20% coinsurance for contact lenses, though eyewear upgrades and other eye exam services are not covered.
Dental Services See details
Alterwood Advantage Choice (HMO) features partially covered dental services with an annual maximum benefit of $3,600, where Medicare-covered dental has a $40 copay and no coinsurance. Preventive care is available with no copay and no coinsurance, and comprehensive services require a 20% coinsurance and no copay, though other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Alterwood Advantage Choice (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Alterwood Advantage Choice (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Alterwood Advantage Choice (HMO) covers medical equipment with no copay, though prior authorization is required. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Alterwood Advantage Choice (HMO) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic procedures, tests, and lab services are provided with no copay and no coinsurance, while outpatient X-rays require a $20 copay plus coinsurance, diagnostic radiological services require a minimum $165 copay, and therapeutic radiological services carry a 20% coinsurance plus a copay.
Home Health Services See details
Alterwood Advantage Choice (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Alterwood Advantage Choice (HMO) covers cardiac rehabilitation services with no coinsurance, but only some services are covered. Specific services such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, with copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Alterwood Advantage Choice (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by Alterwood Advantage Choice (HMO), which provides over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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