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2020 Dual Prime (HMO-SNP)

The Dual Prime plan (HMO-SNP) is a Medicare Advantage Prescription Drug Plan for those with both Medicare and Medicaid (Maryland Medical Assistance Program) as a Qualified Medicare Beneficiary (QMB) or a Full Benefit Dual Eligible (FBDE).  This plan combines your Medical, Hospital and Prescription Drug coverage with extra services and personalized programs focused on improving your health. 

To be eligible for the University of Maryland Health Advantage Dual (HMO-SNP) plan, you must also have Medicare Parts A & B and reside in the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Howard, Harford, Kent, Montgomery, Prince Georges, Queen Anne’s, and Talbot.

How Much You Pay for Covered Services

Benefits What You Pay with Dual Prime

Monthly Plan Premium

$0 - $28.40

Maximum Out-of-Pocket

$6,700

Part B Benefits Deductible

$0

Primary Care Physician Visit

$0 or 20% coinsurance**

Specialist Visit

$0 or 20% coinsurance**

Inpatient Hospital Care

Days 1-60: $0 per day
Days 61-90: $0 per day
Days 91-150: $0 per Lifetime Reserve Day

Emergency Care

$0 or 20% coinsurance**

Durable Medical Equipment

$0 or 20% coinsurance**

Part D Deductible

$0

Prescription Drug Coverage
(30-day supply)

  • For generic drugs (including brand drugs treated as generic), you pay either: $0, $1.30, or $3.60 copay.**
  • For all other drugs, you pay either: $0, $3.90, or $8.95 copay.**

Preventive Services

$0 copayment

Routine Podiatry

  • Medicare Covered Services: $0
  • Routine Foot Care: 4 visits per year $0 copay

Transportation

$0 copayment for 36 one-way trips per year

Preventive Dental

$0 copayment

  • Oral exams: every 6 months
  • Comprehensive oral exam: every 36 months
  • Prophylaxis: every 6 months
  • Fluoride treatment: every 6 months
  • Palliative treatment: 3 every 12 months
  • Bitewing x-ray: once per 12 months
  • Panoramic x-ray: once every 36 months
  • Vertical bitewing x-ray: once every 36 months
  • Intraoral imaging: once every 36 months
Comprehensive Dental

Coverage limit is $800 every year. Member is responsible for all costs over $800 annual maximum. $0 copay for the following:

  • Restorative services: 1 restoration per tooth once every 24 months
  • Endodontics: 1 per lifetime, per patient, per tooth
  • Crowns: once per tooth per 60 months
  • Simple Extractions
  • Periodontics: 1 per quadran of scaling every 36 months
  • Dentures: once every 60 months (not included under $800 dental allowance)
  • Denture repairs: once every 12 months
  • Denture relines/rebase: once every 36 months
  • Denture adjustments: 2 per 12 months
Routine Hearing and Hearing Aids
  • Medicare-covered exam to diagnose and treat hearing and balance issues: $0 copay
  • Routine hearing exam (1 per year): $0 copay
  • 1 fitting and evaluation with 3 follow up visits within the first year from date of initial fitting: $0 copay
Our plan pays up to $1,350 every 3 years for hearing aids
Routine Vision
  • Medicare-covered exam for diagnosis and treatment of diseases and injuries of the eye: $0 copay
  • Routine Eye Exam (1 per year): $0 copay

Our plan pays up to $150 annually towards the purchase of eyewear

Over-The-Counter

 $150 quarterly allowance through UMHA OTC Catalog

Meals

$0 copay for up to 14 meals per 1 week period

Bathroom Safety Devices $0 copay for 2 devices each year

**If Medicaid status changes from Full Benefit Dual Eligible (FBDE) or Qualified Medicare Beneficiary (QMB), your copays and coinsurances will increase to 20% of the total cost of the service and 25% of the total cost of the Part D drug.

Dual Prime (HMO-SNP) covers all Medicare benefits plus:

  • Prescription Drugs
  • Preventive and Comprehensive Dental (dentures included)
  • Vision
  • Over-the-Counter Drugs and Products
  • Meals post discharge
  • Transportation
  • Hearing Exams and Hearing Aids
  • Annual Physical Exam
  • Care Management
  • Bathroom Safety Devices

2020 Enrollment Form