Johns Hopkins Advantage MD

Johns Hopkins Medicine Medicare Plan

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Potential Members: 888-403-7682 (TTY: 711)† or Request a Call
Current Members: PPO: 877-293-5325 (TTY: 711)†
HMO: 877-293-4998 (TTY: 711)†
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If you choose to provide us with personal information by sending an email, or by filling out a form with your personal information and submitting it through our Web site, we use that information to respond to your message and to help us provide you with information or material that you request. We do not give, share, sell, or transfer any personal information to a third party unless required by law.

2024 HMO

Plan Overview

$20 / month
This plan does not have any medical deductibles.
Medical Deductible
$0
Pharmacy Deductible
Enroll Now

Coverage Details
Medical
Medical Deductible

This plan does not have any medical deductibles.

Primary Care Provider Visit

$0 copay

Specialist Visit

$45 copay

Referrals

Required for Specialist Visits only

Urgent Care

$50 copay
The copay is not waived if you are admitted to the hospital.

Telehealth

$0 copay

Ambulatory Surgical Centers Outpatient Surgery

$225 copay

Emergency Care

$100 copay
The copay is waived if you are admitted to the hospital within 24 hours for the same condition.

Worldwide Emergency & Urgently Needed Services

Not covered

Inpatient Hospital Stay

$350/day copay for days 1-5; $0 copay for days 6-90.

Medicare allows 60 "lifetime reserve" days.

Routine Podiatry Services

20% coinsurance (up to 8 times per year)

Acupuncture

Medicare-covered acupuncture:
20% coinsurance

Routine Chiropractic Services

Medicare-covered chiropractic care:
$15 copay

Hearing Aid Services

Learn more

$0 copay (hearing exam)

Hearing aids:
You pay a $699 copay per aid for Advanced hearing aids or $999 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year).

Flex Card

Learn more

N/A

Silver&Fit® Program

Learn more

You pay nothing at participating fitness centers.

Prescription
Pharmacy Deductible

$0

Mail Order

Available

Preferred Generic (Tier 1)

$0 for a one-month supply
$0 for a two-month supply
$0 for a three-month supply

Generic (Tier 2)

$10 for a one-month supply
$15 for a two-month supply
$20 for a three-month supply

Preferred Brand (Tier 3)

$47 ($35 for Select Insulins) for a one-month supply
$94 ($70 for Select Insulins) for a two-month supply
$141 ($105 for Select Insulins) for a three-month supply

Non-Preferred Drug (Tier 4)

$100 ($35 for Select Insulins) for a one-month supply
$200 ($70 for Select Insulins) for a two-month supply
$300 ($105 for Select Insulins) for a three-month supply

Specialty Tier (Tier 5)

33% of the total cost of a one-month supply (long-term supply is not available)

Vision
Medicare-covered exam to diagnose and treat diseases and conditions of the eye

$50 copay

Yearly Glaucoma Screening

You pay nothing

Routine Eye Exam

You pay nothing

Eyeglasses or Contact Lenses after Cataract Surgery

You pay nothing

Routine Eyewear

Our plan pays up to $250 every year for supplemental eyewear (retail or online) from any provider

Dental
Medicare-covered Dental Services

20% coinsurance

Preventive Dental Services

Cleaning(s) (1 cleaning per year): $20 copay
Oral exam(s) (Frequency determined by type of oral exam):
$20 copay

Fluoride Treatments

Not covered

Comprehensive Dental Services

Not covered

Optional Supplemental Benefits

$23

Restorative services (such as inlays, onlays, crowns, resin restoration, etc.)

Frequency dependent on procedure.
In-network & Out-of-network: $50 copay

Endodontics

Frequency dependent on procedure.
In-network & Out-of-network: $100 copay

Periodontics

Frequency dependent on procedure.
In-network & Out-of-network: $50 copay

Extractions

Frequency dependent on procedure.
In-network & Out-of-network: $100 copay

Prosthodontics/Other oral/maxillofacial surgery/Other services (such as removable complete and partial dentures, repair or replace teeth in dentures, removal of exostosis, anesthesia, etc.)

Frequency dependent on procedure.
In-network & Out-of-Network: $50-$100 copay depending on the service

Please note: the information in this section does not apply to Advantage MD Group.

2025 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD Tribute (HMO) has an in-network out-of-pocket maximum of $6,800. Johns Hopkins Advantage MD (PPO), Johns Hopkins Advantage MD Plus (PPO), Johns Hopkins Advantage MD Primary (PPO) have an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $8,850.

For out-of-network benefits, you pay a percentage for most covered services.

Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Tribute (HMO) and Johns Hopkins Advantage MD Primary (PPO) plan has a $2,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD (PPO) plan has a $1,000 Annual Maximum.The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $2,500 Annual Maximum.

Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).

2024 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD Tribute (HMO) has an in-network out-of-pocket maximum of $6,400. Johns Hopkins Advantage MD (PPO), Johns Hopkins Advantage MD Plus (PPO), Johns Hopkins Advantage MD Primary (PPO), & Johns Hopkins Advantage MD Premier (PPO) have an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $8,850.

For out-of-network benefits, you pay a percentage for most covered services.

Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Tribute (HMO) and Johns Hopkins Advantage MD Primary (PPO) plan has a $2,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD (PPO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Premier (PPO) plan has a $1,500 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $2,500 Annual Maximum.

Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).

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Prospective Members:

1-888-403-7682

Current Members:

PPO: 1-877-293-5325
HMO: 1-877-293-4998

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