Which Plan Is Right For Me?
Compare Advantage MD and Advantage MD Plus side-by-side using the chart below, or use our Benefits Explorer interactive tool.
Switch between Medicare Plans and Supplemental Dental Plan
Medicare Plans
Supplemental Dental Plan| 2017 Advantage MD PPO Plans* | |||
|---|---|---|---|
| Plans & Monthly Plan Premium | |||
| Plans & Monthly Plan Premium |
Johns Hopkins
|
Johns Hopkins
|
ORIGINAL MEDICARE
|
| MEDICAL BENEFITS (Partial listing: In-network) | |||
| MEDICAL BENEFITS (Partial listing: In-network) | |||
| Medical Deductible | |||
| Medical Deductible | $0 | $0 | Part A $1,316 & Part B $183 |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | $10 copay | $5 copay | 20% of the cost |
| Specialist Visit | |||
| Specialist Visit | $50 copay | $40 copay | 20% of the cost |
| Referrals | |||
| Referrals | Not required | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $50 copay | $40 copay | 20% of the cost |
| Outpatient Surgery, ASC | |||
| Outpatient Surgery, ASC | $275 copay | $200 copay | 20% of the cost |
| Emergency Care | |||
| Emergency Care | $75 copay | $75 copay | 20% of the cost |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $275/day copay for days 1-7; $0 copay for days 8-90 | $250/day copay for days 1-7; $0 copay for days 8 and beyond | $1,316 deductible for days 1-60; $329/day copay for days 61-90; $658/day copay for 60 lifetime reserve days |
| Annual Routine Vision Exam | |||
| Annual Routine Vision Exam | $10 copay | $0 copay; up to $150 every other year for eyewear | 20% of the cost |
| Empty Header | |||
|---|---|---|---|
| Diagnostic Dental Services | |||
| Diagnostic Dental Services | $30-$55 copay, depending on service | $20-$40 copay, depending on service | Limited coverage |
| Supplemental Dental | |||
| Supplemental Dental | Optional | Optional | 20% of the cost |
| Chiropractic Care | |||
| Chiropractic Care | $20 copay | $20 copay | 20% of the cost |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More |
N/A | Two options available; copay from $699 per aid | 20% of the cost |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More |
N/A | Included | Not covered |
| PRESCRIPTION DRUG BENEFITS (30-day supply; preferred network pharmacy) | |||
| PRESCRIPTION DRUG BENEFITS (30-day supply; preferred network pharmacy) | |||
| Deductible | |||
| Deductible | $0 | $0 | Not covered |
| Preferred Generic | |||
| Preferred Generic | $7 copay | $4 copay | Not covered |
| Generic | |||
| Generic | $15 copay | $12 copay | Not covered |
| Preferred Brand | |||
| Preferred Brand | $45 copay | $42 copay | Not covered |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $95 copay | $92 copay | Not covered |
| Specialty Tier | |||
| Specialty Tier | 33% of the cost | 33% of the cost | Not covered |
| Mail Order Available | |||
| Mail Order Available | When ordering 90-day supply | When ordering 90-day supply | Not covered |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $6,700 and a combined in- and out-of-network maximum of $10,000 for 2017. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $6,700 and a combined in- and out-of-network maximum of $10,000 for 2017. For out-of-network benefits, you pay a percentage for most covered services.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.
You must continue to pay your Part B premium.
| 2017 Advantage MD Dental PPO* | |
|---|---|
| Plans & Monthly Plan Premium | |
| Plans & Monthly Plan Premium |
Johns Hopkins
|
| BASIC RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| BASIC RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| Endodontics | |
| Endodontics | $200 copay |
| Oral Surgery | |
| Oral Surgery | $50 copay |
| Oral Pathology Biopsy | |
| Oral Pathology Biopsy | $50 copay |
| Periodontics | |
| Periodontics | $50 copay |
| Restorative Fillings | |
| Restorative Fillings | $50 copay |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) |
|
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) |
$50 copay |
| MAJOR RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| MAJOR RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) |
|
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) |
$400 copay |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) |
|
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) |
$50 copay |
| Empty Header | |
|---|---|
| Bridges Replacement (due to structural changes in the mouth) |
|
| Bridges Replacement (due to structural changes in the mouth) |
$400 copay |
| Crowns, Inlays and Onlays Installation | |
| Crowns, Inlays and Onlays Installation | $400 copay |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) |
|
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) |
$50 copay |
| Crowns, Inlays and Onlays Replacement | |
| Crowns, Inlays and Onlays Replacement | $400 copay |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) |
|
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) |
$400 copay |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) |
|
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) |
$50 copay |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) |
|
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) |
$400 copay |
*Please note: this information does not apply to Advantage MD Group.
Limitations: 1. After enrolling in the supplemental dental plan, there is a six-month waiting period before these services will be covered. 2. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 3. $1,200 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).
A Doctor, Specialist or Hospitalhttps://medicareadvantage.healthtrioconnect.com/public-app/consumer/provdir/entry.page
A Dental Providerhttps://govservices.dentaquest.com/Router.jsp?component=Main&source=Logon&action=ProviderDirectory2&state=MD&locale=en
A Vision Providerhttps://www.superiorvision.com/Member/locate_provider
A Prescription Drughttps://www.medicareplanrx.com/jccf/Johnshopkins_formulary_17.html
A Pharmacyhttps://www.medicareplanrx.com/jccf/johnshopkins_pharmacy_17.html
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
If you want a Provider Directory mailed to you, or if you need help finding an in-network provider, please call 1-877-293-5325 (TTY:711) October 1 through February 14, Monday through Sunday 8 a.m. to 8 p.m., and February 15 through September 30, Monday through Friday 8 a.m. to 8 p.m.
If you are looking for a medical equipment provider, please call Customer Service at 1-877-293-5325 (TTY:711).
The online Vision Directory is not an all inclusive list of vision providers. You can also find vision providers by searching through the online directory link above. Search for a specialist/vendor and select the specialty you are interested in from the list under specialty.
Find doctors, hospitals, prescription drugs, and pharmacies within the Advantage MD network.
Explanation of Hearing Aid Coverage for Advantage MD Plus Members
Johns Hopkins Advantage MD Plus covers up to two Flyte hearing aids per year when purchased through TruHearing. Flyte hearing aids are compatible with iPhone®, iPad®, and iPod® touch, and are available in a variety of styles in both advanced and premium features.
Included with hearing aids
- 3 follow-up visits with an in-network provider for fitting and adjustment of hearing aids
- 45-day trial period
- 3-year manufacturer warranty for repairs and one-time loss and damage replacement
- 48 batteries per aid
Copays
- Flyte™ 700: $699 per aid
- Flyte™ 900: $999 per aid
- Initial hearing exam: $40
For more details about coverage, read the TruHearing flier.
To get started, call TruHearing to schedule a hearing exam today: 1-844-341-9735 (TTY: 1-800-975-2674)
The Silver&Fit® Exercise and Healthy Aging Program
The Silver&Fit® program is designed for older adults and is provided at no additional cost for members who choose the Advantage MD Plus plan. With this program, you may choose one out of the following two enrollment options:
- Work out at a participating fitness facility. Enjoy all of the standard amenities* of the fitness facility including cardiovascular and strength training equipment.
- Work out at home. If you choose the Home Fitness program, you can order up to two home fitness kits per benefit year. Choose from a selection of 17 kits including: yoga, Chair Pilates, tai chi, cardio strength, and many others.
You also have access to the following Silver&Fit® program features:
- Healthy Aging education classes (online or have DVDs mailed to you)
- The Silver Slate® – Stay up-to-date on fitness, nutrition, and weight management with our newsletter
- The Silver&Fit Connected!™ Program – a fun and easy way to track exercise at a facility or through a wearable fitness device**
- Earn Rewards** for tracking your activity
*Services that require an additional cost are not included.
**Rewards subject to change; purchase of device or app is not included.
Learn more and see what fitness facilities participate by going to www.silverandfit.com.
The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit®, Silver&Fit Connected!™ and The Silver Slate® are trademarks of ASH and used with permission herein. All programs and services are not available in all areas.
Please note: the information in this section does not apply to Advantage MD Group.
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