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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 $40.00. 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 an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $8.00, while standard generic drugs have a $47.00 copay. Preferred brand drugs have a $100.00 copay, and non-preferred drugs have 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Alterwood Advantage Choice (HMO) plan offers a variety of benefits, including coverage for inpatient and outpatient services, primary care, hearing, vision, and dental. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. The plan also covers ambulance services, emergency services, and home health services with no copay. The plan covers preventive services with no copay, and offers a range of specialist services with varying copays. Additional benefits include coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facilities. The plan also offers over-the-counter items, meal benefits, and nicotine replacement therapy.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $350 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $335 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered by the Alterwood Advantage Choice (HMO) plan. Outpatient hospital services have a $350 copay, observation services have a $200 copay, ambulatory surgical center (ASC) services have a $175 copay, individual outpatient substance abuse sessions have a copay between $30 and $30, and group outpatient substance abuse sessions have a copay between $20 and $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alterwood Advantage Choice (HMO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alterwood Advantage Choice (HMO) plan. Ground ambulance services have a $240 copay, while air ambulance services have a $300 copay. Transportation services to plan-approved health-related locations are covered for up to 8 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay and no coinsurance, and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Alterwood Advantage Choice (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $30 copay, mental health specialty services with a copay between $20-$30, podiatry services with a $35 copay, and physical therapy and speech-language pathology services with a $30 copay. Additionally, there is no copay for additional telehealth benefits, and opioid treatment program services have a $35 copay.
Preventive Services See details
The Alterwood Advantage Choice (HMO) plan covers preventive services, including Medicare-covered services with no copay, and other services like re-admission prevention, kidney disease education services, and glaucoma screening. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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.
Hearing Services See details
Hearing services 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, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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, with a combined maximum benefit of $150 per year. Routine eye exams have no copay, while upgrades are not covered.
Dental Services See details
The Alterwood Advantage Choice (HMO) plan covers dental services, including oral exams with a $40 copay, and other dental services up to a $2,500 maximum per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with a 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 by the Alterwood Advantage Choice (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 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Alterwood Advantage Choice (HMO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have between 0% and 20% coinsurance. Diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and outpatient X-ray services with a $20 copay; Diagnostic Radiological Services have a copay of at least $225, and Therapeutic Radiological Services have 20% coinsurance. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Alterwood Advantage Choice (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
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 by the Alterwood Advantage Choice (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
The Alterwood Advantage Choice (HMO) plan's "Other Services" benefit covers over-the-counter items, meal benefits, and other services, although acupuncture and several other services are not covered. The plan provides Over-the-Counter (OTC) Items as a supplemental benefit, offers nicotine replacement therapy (NRT) and naloxone coverage, and covers all drugs on the CMS OTC list. The meal benefit is provided for a limited duration following surgery or hospitalization and for certain chronic illnesses.
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