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Alterwood Advantage Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alterwood Advantage Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alterwood Advantage Select (HMO) in 2025, please refer to our full plan details page.
Alterwood Advantage Select (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 Select (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 Select (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 Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. You must continue to pay paying your reduced 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 a $295.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Select (HMO) plan has a $295 deductible for prescription drugs. After the deductible is met, you will pay the following for your prescriptions. For preferred generic drugs, there is no copay at standard or mail-order pharmacies. For standard generic drugs, the copay is $47.00 at both standard and mail-order pharmacies. For preferred brand drugs, the copay is $100.00 at both standard and mail-order pharmacies. For non-preferred drugs, you will pay 29% coinsurance at both standard and mail-order pharmacies. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Alterwood Advantage Select (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $395 copay for the first four days, and no copay for days 5-90. Outpatient services have different copays based on the service, and primary care visits have no copay. This plan also covers several other services, including ambulance, emergency, and vision services, with copays and coinsurance applying to different services. Dental services are covered with a $40 copay for Medicare dental services and other services covered with 20% coinsurance up to a $4,000 annual limit. Home health services, skilled nursing facilities, and many other services are also covered, with some requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4, there is a $395 copay, and for days 5-90, there is no copay; there is no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $375 copay, observation services have a $250 copay, and ambulatory surgical center services have a $195 copay. Individual and group sessions for outpatient substance abuse have a copay between $35 and $45.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alterwood Advantage Select (HMO) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services; however, prior authorization is required. Ground ambulance services have a $240 copay, and air ambulance services have a $300 copay. Transportation Services to a plan-approved health-related location are covered for 10 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Alterwood Advantage Select (HMO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have no copay; both services have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Alterwood Advantage Select (HMO) plan covers primary care physician services with no copay, and covers chiropractic services with a $15 copay for each visit. Occupational therapy services have a $35 copay, while physician specialist services have a $25 copay. Mental health specialty services have a $45 copay for individual sessions and a $35 copay for group sessions. Podiatry services, other health care professional services, psychiatric services, and opioid treatment program services all have a minimum copay of $35. Physical therapy and speech-language pathology services have a $50 copay, and additional telehealth benefits have no copay.
Preventive Services See details
The Alterwood Advantage Select (HMO) plan covers several preventive services, including Medicare-covered services with no copay, and additional preventive services. The plan does not cover annual physical exams, and some additional services such as health education, in-home safety assessments, and others.
Hearing Services See details
The Alterwood Advantage Select (HMO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered. The plan covers prescription hearing aids (all types) with a copay between $475 and $1950.
Vision Services See details
The Alterwood Advantage Select (HMO) plan covers vision services including eye exams, with a $40 copay, and eyewear with 20% coinsurance. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with a combined maximum benefit of $400 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services. Other dental services have a maximum plan benefit coverage of $4,000 per year, with Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment 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.
Dialysis Services See details
Dialysis Services are covered by the Alterwood Advantage Select (HMO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment is covered under the Alterwood Advantage Select (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a $15 copay for Diagnostic Procedures/Tests and no copay for Lab Services. Diagnostic Radiological Services have a copay of at least $210, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered under the Alterwood Advantage Select (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. The copay for covered services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alterwood Advantage Select (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefit, while 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. The plan offers OTC items, including nicotine replacement therapy and Naloxone, as a Part C benefit.
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