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2019 UMHA Dual (HMO-SNP)

The UMHA Dual 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 UMHA Dual

Monthly Plan Premium

$0 - $27.80

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, $1.25, or $3.40 copay.**
  •  For all other drugs, you pay either: $0, $3.80, or $8.50 copay.**

Preventive Services

$0 copayment

Routine Podiatry

  • Medicare Covered Services: $0
  • Routine Foot Care: 6 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 3 years
  • Prophylaxis: every 6 months
  • Fluoride treatment: every 6 months
  • Palliative treatment: 3 every year
  • Bitewing x-ray: once per year
  • Panoramic x-ray: once every 3 years
  • Vertical bitewing x-ray: once every 3 years
  • Intraoral imaging: once every 3 years
Comprehensive Dental

Coverage limit is $1,500 every year. Member is responsible for all costs over $1,500 annual maximum. $0 copay for the following:

  • Restorative services: 1 restoration per tooth once every 24 months - not to exceed 6 surfaces per year
  • Endodontics: 1 per lifetime, per patient, per tooth
  • Crowns: once per tooth per 5 years
  • Extractions: 1 extraction per tooth
  • Periodontics: 1 per quadran of scaling every 36 months
  • Dentures: once every 5 years
  • Denture repairs: once every 12 months
  • Denture relines/rebase: once every 36 months
  • Denture adjustments: 2 per year, not included under $1,500 dental limit
Routine Hearing and Hearing Aids
  • Exam to diagnose and treat hearing and balance issues: $0 copay
  • Routine hearing exam (for up to 1 every year): $0 copay
  • Hearing aid fitting/evaluation (up to 1 every 3 years): $0 copay
  • Our plan pays up to $750 every year for hearing aids

Over-The-Counter

$110 monthly allowance through UMHA OTC Catalog

Meals

$0 copay for up to 18 meals post-discharge from inpatient stay

**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.

UMHA Dual (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
  • 24/7 Nurse Hotline