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2018 University of Maryland Health Advantage Dual (HMO-SNP)

The University of Maryland Health Advantage 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 University
of Maryland Health Advantage Dual

Monthly Plan Premium

$0 - $33.70

Maximum Out-of-Pocket

$6,700

Part B Benefits Deductible

$0 - $183

These are 2017 amounts and may change January 1, 2018.

Primary Care Physician Visit

$0 or 20% coinsurance**

Specialist Visit

$0 or 20% coinsurance**

Inpatient Hospital Care

Days 1-60: $0 - $1,1316 deductible
Days 61-90: $0 - $329 per day
Days 91-150: Lifetime Reserve Days
$0 - $658 per day

These are 2017 amounts and may change January 1, 2018.

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 $3.35 copay.
  •  For all other drugs, you pay either: $0, $3.70, or $8.35 copay.

Preventive Services

$0 copayment

Routine Podiatry

$0 copayment

Transportation
24 one-way trips per year

$0 copayment

Preventive Dental

$0 copayment

  • Periodic oral exams (every 6 months)
  • Cleaning every 6 months
  • Fluoride treatments once every 6 months
  • Dental x-rays (every 12 months)
Comprehensive Dental

$0 copayment per visit. The Plan pays a maximum benefit amount of $1,000 per calendar year for Comprehensive Dental Services for Dentures, Denture Adjustments, Periodontics, and Restorative Services.

  • Comprehensive oral evaluation (every 3 years)
  • Bitewing x-rays (2 or 4 films) once per year
  • Endodontics (once per lifetime, per tooth)
  • Extractions (no limit)
  • Restorative services (4 per year, not to exceed 6 surfaces per year)
  • Periodontics (once per year)
  • Dentures (once every 3 years)
Denture adjustments once per calendar year
Routine Hearing and Hearing Aids

$0 copayment for 1 hearing test, once per year

$0 copayment for:

  • Hearing Aid Evaluation and Fitting – Three (3) follow-up visits during the first year from the date of the initial fitting.
  • Hearing Aids – Once every three (3) years.
  • Ear molds – First set, when needed
  • Three (3)-year hearing aid battery supply (up to 48 batteries per year, per hearing aid.)
  • Three (3)-year manufacturer repair warranty.
  • One-time replacement coverage for Lost, Stolen or Damaged Hearing Aid (per hearing aid).

If your hearing aid is lost, stolen or damaged, you will be financially responsible for a $195 deductible per hearing aid. The plan pays the balance after the deductible has been met.

Over-The-Counter

$60 quarterly allowance

Meals

$0 (up to 42 meals post discharge)

** If you are eligible for Medicare cost-sharing assistance under Medicaid, you pay $0.

University of Maryland Health Advantage Dual (HMO-SNP) covers all Medicare benefits plus:

  • Prescription Drugs
  • Preventive and Comprehensive Dental (dentures included)
  • Vision
  • Over-the-Counter Drugs and Products
  • Transportation
  • Hearing Exams and Hearing Aids
  • Annual Physical Exam
  • Care Management
  • 24/7 Nurse Hotline