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April 1 – September 30 | 8 am – 8 pm EST | Monday – Friday
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2021 Dual Prime Plan (HMO-SNP)

The 2021 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 - $32.30 (Depending on your level of extra help)

Maximum Out-of-Pocket

$7,550

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 $3.70 copay.**
  • For all other drugs, you pay either: $0, $4, or $9.20 copay.**

Preventive Services

$0 copayment

Routine Podiatry

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

Transportation

$0 copayment for 24 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 $1,000 every year. Member is responsible for all costs over $1,000 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 quadrant of scaling every 36 months
  • Dentures: once every 60 months (not included under $1,000 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

 $90 quarterly allowance through UMHA OTC Catalog

 Health & Wellness Program $0 copay - 1 at-home fitness kit per quarter

Personal Emergency

Response System (PERS)
$0 copay - available to select members living with a disability or chronic condition such as COPD, CHF, Diabetes, or ESRD

Meals with Medical Nutrition Therapy

$0 copay - 12 consecutive weeks of meals for members with COPD, CHF, Diabetes, or ESRD. Members will also receive up to 4 medical nutrition therapy sessions

Readmission Prevention $0 copay - 14 meals per 1-week period for members post-discharge from an inpatient stay. PERS will also be available to select members upon discharge for a defined period of time.
Bathroom Safety Devices $0 copay for 2 devices each year ordered through UMHA Bathroom Safety Catalog
Healthy Rewards Program $15 reward cards for completing select preventive services

**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.

2021 Enrollment Form