2027 Plus (PPO)

Plan Overview

$165 / month

Medical Deductible

This plan does not have any medical deductibles.

Pharmacy Deductible

$615 (Applies to drugs in Tiers 3, 4 and 5)

Coverage Details

Maryland counties: Anne Arundel, Baltimore, Carroll, Frederick, Howard, Montgomery, Somerset, Washington, Wicomico and Worcester.

Medical

Medical Deductible	This plan does not have any medical deductibles.
Primary Care Provider Visit	In-network: $0 copay Out-of-network: 30% coinsurance
Specialist Visit	In-network: $40 copay Out-of-network: 30% coinsurance
Referrals	Not required
Telehealth	In-network: $0 copay Out-of-network: 30% coinsurance
Urgent Care	In-network & Out-of-network: $40 copay The copay is not waived if you are admitted to the hospital.
Emergency Care	In-network & Out-of-network: $115 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition.
Worldwide Emergency & Urgently Needed Services	$115 for emergency care services and $40 copay for urgent care services. Emergency and urgent care services are covered up to a maximum of $50,000 each year.
Inpatient Hospital Stay	In-network: $350/day for days 1-6; $0 copay for days 7-90 Out-of-network: 30% coinsurance per stay
Outpatient Surgery	In-network: $250 copay at an Ambulatory Surgical Center $320 copay at an Outpatient Hospital Facility $0 copay for diagnostic colonoscopies Out-of-network: 30% coinsurance
Acupuncture	Medicare-covered Acupuncture: In-Network: $0 – $40 copay, based on location of service Out-of-Network: 30% coinsurance Non-Medicare covered Acupuncture: In and Out-of-Network: $0 copay, up to $200 allowance
Chiropractic Services	Medicare-covered Chiropractic Services: In-network: $15 copay Out-of-network: 30% coinsurance Non-Medicare covered Chiropractic Services: $20 copay (up to 12 visits per year) Out-of-network: 30% coinsurance
Podiatry Services	Medicare-covered Podiatry Services: In-network: $40 copay Out-of-network: 30% coinsurance Routine Foot Care: In-network: 20% coinsurance (up to 6 visits a year) Out-of-network: 30% coinsurance
Hearing Services Learn more	In-network: $40 copay for diagnostic hearing exams $0 copay for routine hearing exams $0 copay for fitting and evaluation for hearing aids $699 copay per hearing aid for Advanced hearing aids OR $999 copay per aid for Premium hearing aids. Up to two TruHearing-branded hearing aids each year (one per ear per year). Out-of-network: 30% coinsurance for diagnostic hearing exams 80% coinsurance for routine hearing exams, fitting and evaluation for hearing aids, and for hearing aids (one per ear per year).
OTC Allowance	$25 per quarter
Silver&Fit® Program Learn more	$0 copay for participating fitness centers.
Prescription
Pharmacy Deductible	$615 (Applies to drugs in Tiers 3, 4 and 5)
Preferred Generic (Tier 1)	$0 copay for a 30-day supply $0 copay for a 60-day supply $0 copay for a 100-day supply
Generic (Tier 2)	$15 copay for a 30-day supply $22.50 copay for a 60-day supply $30 copay for a 100-day supply
Preferred Brand (Tier 3)	25% co-insurance ($35 for all insulins) for a 30-day supply 25% co-insurance ($70 for all insulins) for a 60-day supply 25% co-insurance ($105 for all insulins) for a 100-day supply
Non-Preferred Drug (Tier 4)	25% co-insurance ($35 for all insulins) for a 30-day supply 25% co-insurance ($70 for all insulins) for a 60-day supply 25% co-insurance ($105 for all insulins) for a 100-day supply
Specialty Tier (Tier 5)	26% co-insurance for a 30-day supply (only)
Mail Order	Available — Get eligible prescription medications delivered directly to your home. Mail order may be available for up to a 100-day supply of many maintenance medications. Contact Member Services to learn how to get started.
Vision
Medicare-covered exam to diagnose and treat diseases and conditions of the eye	In-network: $40 copay Out-of-network: 30% coinsurance
Yearly Glaucoma Screening	In-network: $0 copay Out-of-network: 30% coinsurance
Routine Eye Exam	(1 every year) In-network: $0 copay Out-of-network: 45% coinsurance
Eyeglasses or Contact Lenses after Cataract Surgery	In-network: $0 copay Out-of-network: 30% coinsurance
Routine Eyewear	In-Network: Our plan pays up to $250 every year for supplemental eyewear from any in-network Superior Vision provider. Out-of-Network: 30% coinsurance, up to $250.
Dental
Medicare-covered Dental Services	In-network: $0 copay Out-of-network: 30% coinsurance
Preventive Dental Services	(2 cleanings per year): In-network: $0 copay Out-of-network: 30% coinsurance Oral exam(s) (Frequency determined by type of oral exam): In-network: $0 copay Out-of-network: 30% coinsurance Dental X-Ray(s) (Frequency determined by type of X-Ray): In-network: $0 copay Out-of-network: 30% coinsurance
Fluoride Treatments	(2 fluoride treatments per year): In-network: $0 copay Out-of-network: 30% coinsurance
Comprehensive Dental Services	Not covered
Optional Supplemental Benefits	$21 monthly premium The plan has a maximum coverage amount of $1,000 per year for in-and out-of-network non-Medicare-covered comprehensive dental services. Members are responsible for the difference between the allowed amount and the billed amount for any out-of-network services.
Restorative services (such as inlays, onlays, crowns, resin restoration, etc.)	In-network & Out-of-network: $50 copay
Endodontics	In-network & Out-of-network: $100 copay
Periodontics	In-network & Out-of-network: $50 copay
Extractions	In-network & Out-of-network: $100 copay
Prosthodontics (fixed & removable), Implants, and Oral & Maxillofacial Surgery	In-network & Out-of-network: $50-100 copay, depending on service
Documents
2027 Evidence of Coverage (PPO Plus) 2027 Annual Notice of Changes (Plus PPO) 2027 Summary of Benefits (PPO) 2027 PPO LIS Premium Summary Chart 2027 Pre-Enrollment Checklist – English \| Spanish

2027 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $8,950. Johns Hopkins Advantage MD Tribute (HMO) has an in-network out-of-pocket maximum of $7,200. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,950 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD Plus (PPO) has 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 Access (PPO) has an in-network out-of-pocket maximum of $8,000 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD BMORE Balanced (HMO-DSNP) and Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $9,850. Johns Hopkins Advantage MD Select (HMO) has an in-network out-of-pocket maximum of $9,250.

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. Johns Hopkins Advantage MD BMORE Balanced (HMO-DSNP) and Johns Hopkins Advantage MD Access (PPO) have a $1,000 allowance for comprehensive dental services added to your Flex Card. Johns Hopkins Advantage MD D-SNP (HMO) has $1,000 annual maximum for comprehensive dental services. Johns Hopkins Advantage MD Select (HMO) has $1,500 annual maximum for comprehensive dental services. Johns Hopkins Advantage MD Tribute (HMO) has $2,000 annual maximum for comprehensive dental services.

Prior authorizations may be required for some services, contact Member Services for more details.

2026 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $8,950. 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 $9,250. Johns Hopkins Advantage MD Select (HMO) has an in-network out-of-pocket maximum of $9,250

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), Johns Hopkins Advantage MD (PPO), Johns Hopkins Advantage MD Plus (PPO), and Johns Hopkins Advantage MD Primary (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 D-SNP (HMO) has a $2,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Select (HMO) has a $2,400 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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2027 Plus (PPO)

Plan Overview

Coverage Details

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