Which Plan Is Right for Me?
Compare our Advantage MD plans with Original Medicare using the chart below, or use our interactive tool.
Select a county below to see the chart that applies to you:
Switch between Advantage MD Plans* and Original Medicare
| Advantage MD Plans | ||||
|---|---|---|---|---|
| Plans & Monthly Plan Premium | ||||
| Plans & Monthly Plan Premium | Johns Hopkins | Johns Hopkins | Johns Hopkins | Johns Hopkins |
| MEDICAL BENEFITS (partial listing: in-network) | ||||
| MEDICAL BENEFITS (partial listing: in-network) | ||||
| Medical Deductible | ||||
| Medical Deductible | $0 | $0 | $0 | $0 |
| Primary Care Provider Visit | ||||
| Primary Care Provider Visit | $0 copay | $5 copay | $0 copay | $0 copay |
| Specialist Visit | ||||
| Specialist Visit | $45 copay | $50 copay | $40 copay | $0 copay |
| Referrals | ||||
| Referrals | Required for Specialist Visits only | Not required | Not required | Required for Specialist Visits only |
| Urgent Care | ||||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay. The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. | $0 copay |
| Telemedicine | ||||
| Telemedicine | $0 copay | $5 copay | $0 copay | Not covered |
| Ambulatory Surgical Centers Outpatient Surgery | ||||
| Ambulatory Surgical Centers Outpatient Surgery | $225 copay | $225 copay | $225 copay | $0 copay |
| Emergency Care | ||||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $0 copay |
| Worldwide Emergency & Urgently Needed Services | ||||
| Worldwide Emergency & Urgently Needed Services | Not covered | Not covered | $90 copayment for Emergency Care and $40 copayment for Urgently Needed Services | Not covered |
| Inpatient Hospital Stay | ||||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $330/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days | $330/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days | $0 copay up to 90 days |
| Vision benefits | ||||
| Vision benefits | $50 copay once per year; up to $150 allowance for additional eyewear every two years | $50 copay once per year; no additional eyewear coverage | $40 copay once per year; up to $150 allowance for additional eyewear every two years | $0 copay once per year; up to $150 allowance for additional eyewear every two years |
| Routine Podiatry Services | ||||
| Routine Podiatry Services | 20% coinsurance (up to 8 times per year) | 20% coinsurance (up to 6 times per year) | 20% coinsurance (up to 6 times per year) | Not covered |
| Acupuncture | ||||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain. $200 supplemental benefit for any injury or illness. | $0 copay/coinsurance |
| Preventive Dental Services | ||||
| Preventive Dental Services | $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray) Frequency depends on type of service | $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray) Frequency depends on type of service | $15 copay (cleaning); $15 copay (oral exam); $15 copay (dental x-ray) Frequency depends on type of service | $0 copay (cleaning); $0 copay (oral exam); $0 copay (dental x-ray) Frequency depends on type of service |
| Optional Supplemental Benefits Learn More | ||||
| Optional Supplemental Benefits Learn More | Available for an extra premium ($25) for comprehensive dental. | Available for an extra premium ($25) for comprehensive dental. | Available for an extra premium ($25) for comprehensive dental. | Comprehensive dental included at no additional cost. |
| Routine Chiropractic Services | ||||
| Routine Chiropractic Services | $20 copay | $20 copay | $20 copay | $0 copay |
| Hearing Aid Services Learn More | ||||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) Two options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) Two options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) $1,000 towards TruHearing-branded hearing aids every 24 months. |
| Silver&Fit® Program Learn More | ||||
| Silver&Fit® Program Learn More | Included | Included | Included | Included |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||||
| Deductible | ||||
| Deductible | $0 | $0 | $0 | $0 |
| Preferred Generic | ||||
| Preferred Generic | $0 copay | $4 copay | $4 copay | $0 |
| Generic | ||||
| Generic | $10 copay | $12 copay | $12 copay | 25% or $0/$1.35/$3.95/15% Cost sharing is based on your level of Extra Help |
| Preferred Brand | ||||
| Preferred Brand | $47 copay | $47 copay | $47 copay | 25% or $0/$4.00/$9.85/15% Cost sharing is based on your level of Extra Help |
| Non-Preferred Drug | ||||
| Non-Preferred Drug | $100 copay | $100 copay | $100 copay | 25% or $0/$4.00/$9.85/15% Cost sharing is based on your level of Extra Help |
| Specialty Tier | ||||
| Specialty Tier | 33% of the cost | 33% of the cost | 33% of the cost | 25% or $0/$4.00/$9.85/15% Cost sharing is based on your level of Extra Help |
| Mail Order | ||||
| Mail Order | Available | Available | Available | Available |
| Comprehensive Dental Benefits | ||||
|---|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||||
| Endodontics | ||||
| Endodontics | $100 copay | $100 copay | $100 copay | $0 copay |
| Oral Surgery | ||||
| Oral Surgery | $50 copay | $50 copay | $50 copay | $0 copay |
| Oral Pathology Biopsy | ||||
| Oral Pathology Biopsy | $50 copay | $50 copay | $50 copay | $0 copay |
| Periodontics | ||||
| Periodontics | $50 copay | $50 copay | $50 copay | $0 copay |
| Restorative Fillings | ||||
| Restorative Fillings | $50 copay | $50 copay | $50 copay | $0 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 | $50 copay | $50 copay | $0 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) | $50 copay | $50 copay | $50 copay | $0 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 | $50 copay | $50 copay | $0 copay |
| Bridges Replacement (due to structural changes in the mouth) | ||||
| Bridges Replacement (due to structural changes in the mouth) | $50 copay | $50 copay | $50 copay | $0 copay |
| Crowns, Inlays and Onlays Installation | ||||
| Crowns, Inlays and Onlays Installation | $50 copay | $50 copay | $50 copay | $0 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 | $50 copay | $50 copay | $0 copay |
| Crowns, Inlays and Onlays Replacement | ||||
| Crowns, Inlays and Onlays Replacement | $50 copay | $50 copay | $50 copay | $0 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) | $100 copay | $100 copay | $100 copay | $0 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 | $50 copay | $50 copay | $0 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) | $100 copay | $100 copay | $100 copay | $0 copay |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (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 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 D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550.
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) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $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).
Switch between Advantage MD Plans* and Original Medicare
| Advantage MD Plans | |||
|---|---|---|---|
| Plans & Monthly Plan Premium | |||
| Plans & Monthly Plan Premium | Johns Hopkins | Johns Hopkins | Johns Hopkins |
| MEDICAL BENEFITS (partial listing: in-network) | |||
| MEDICAL BENEFITS (partial listing: in-network) | |||
| Medical Deductible | |||
| Medical Deductible | $0 | $0 | $0 |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | $0 copay | $5 copay | $0 copay |
| Specialist Visit | |||
| Specialist Visit | $45 copay | $50 copay | $40 copay |
| Referrals | |||
| Referrals | Required for Specialist Visits only | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay. The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. |
| Telemedicine | |||
| Telemedicine | $0 copay | $5 copay | $0 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $225 copay | $225 copay | $225 copay |
| Emergency Care | |||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. |
| Worldwide Emergency & Urgently Needed Services | |||
| Worldwide Emergency & Urgently Needed Services | Not covered | Not covered | $90 copayment for Emergency Care and $40 copayment for Urgently Needed Services |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $330/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days | $330/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days |
| Vision Benefits | |||
| Vision Benefits | $50 copay once per year; up to $150 allowance for additional eyewear every two years | $50 copay once per year; no additional eyewear coverage | $40 copay once per year; up to $150 allowance for additional eyewear every two years |
| Routine Podiatry Services | |||
| Routine Podiatry Services | 20% coinsurance (up to 8 times per year) | 20% coinsurance (up to 6 times per year) | 20% coinsurance (up to 6 times per year) |
| Acupuncture | |||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain. $200 supplemental benefit for any injury or illness. |
| Preventive Dental Services | |||
| Preventive Dental Services | $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray) Frequency depends on type of service | $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray) Frequency depends on type of service | $15 copay (cleaning); $15 copay (oral exam); $15 copay (dental x-ray) Frequency depends on type of service |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | Available for an extra premium ($25) for comprehensive dental. | Available for an extra premium ($25) for comprehensive dental. | Available for an extra premium ($25) for comprehensive dental. |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | $20 copay | $20 copay | $20 copay |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) Two options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) Two options available through TruHearing (up to two per year); copay from $699 per aid |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More | Included | Included | Included |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| Deductible | |||
| Deductible | $0 | $0 | $0 |
| Preferred Generic | |||
| Preferred Generic | $0 copay | $4 copay | $4 copay |
| Generic | |||
| Generic | $10 copay | $12 copay | $12 copay |
| Preferred Brand | |||
| Preferred Brand | $47 copay | $47 copay | $47 copay |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 copay | $100 copay | $100 copay |
| Specialty Tier | |||
| Specialty Tier | 33% of the cost | 33% of the cost | 33% of the cost |
| Mail Order | |||
| Mail Order | Available | Available | Available |
| Comprehensive Dental Benefits | |||
|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Endodontics | |||
| Endodontics | $100 copay | $100 copay | $100 copay |
| Oral Surgery | |||
| Oral Surgery | $50 copay | $50 copay | $50 copay |
| Oral Pathology Biopsy | |||
| Oral Pathology Biopsy | $50 copay | $50 copay | $50 copay |
| Periodontics | |||
| Periodontics | $50 copay | $50 copay | $50 copay |
| Restorative Fillings | |||
| Restorative Fillings | $50 copay | $50 copay | $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 | $50 copay | $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) | $50 copay | $50 copay | $50 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 | $50 copay | $50 copay |
| Bridges Replacement (due to structural changes in the mouth) | |||
| Bridges Replacement (due to structural changes in the mouth) | $50 copay | $50 copay | $50 copay |
| Crowns, Inlays and Onlays Installation | |||
| Crowns, Inlays and Onlays Installation | $50 copay | $50 copay | $50 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 | $50 copay | $50 copay |
| Crowns, Inlays and Onlays Replacement | |||
| Crowns, Inlays and Onlays Replacement | $50 copay | $50 copay | $50 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) | $100 copay | $100 copay | $100 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 | $50 copay | $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) | $100 copay | $100 copay | $100 copay |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (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 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.
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) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 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).
Switch between Advantage MD Plans* and Original Medicare
| Advantage MD Plans | |||
|---|---|---|---|
| Plans & Monthly Plan Premium | |||
| Plans & Monthly Plan Premium | Johns Hopkins | Johns Hopkins | Johns Hopkins |
| MEDICAL BENEFITS (partial listing: in-network) | |||
| MEDICAL BENEFITS (partial listing: in-network) | |||
| Medical Deductible | |||
| Medical Deductible | $0 | $0 | $0 |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | $0 copay | $0 copay | $0 copay |
| Specialist Visit | |||
| Specialist Visit | $45 copay | $25 copay | $0 copay |
| Referrals | |||
| Referrals | Required for Specialist Visits only | Not required | Required for Specialist Visits only |
| Urgent Care | |||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay. The copay is not waived if you are admitted to the hospital. | $0 copay |
| Telemedicine | |||
| Telemedicine | $0 copay | $0 copay | Not covered |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $225 copay | $100 copay | $0 copay |
| Emergency Care | |||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $0 copay |
| Worldwide Emergency & Urgently Needed Services | |||
| Worldwide Emergency & Urgently Needed Services | Not covered | $0 copayment for Emergency Care and $0 copayment for Urgently Needed Services | Not covered |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $200/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $0 copay up to 90 days |
| Vision Benefits | |||
| Vision Benefits | $50 copay once per year; up to $150 allowance for additional eyewear every two years | $10 copay once per year; up to $300 allowance for additional eyewear every two years | $0 copay once per year; up to $150 allowance for additional eyewear every two years |
| Routine Podiatry Services | |||
| Routine Podiatry Services | 20% coinsurance (up to 8 times per year) | $10 copay (up to 12 times per year) | Not covered |
| Acupuncture | |||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain. $300 supplemental benefit for any injury or illness. | $0 copay/coinsurance |
| Preventive Dental Services | |||
| Preventive Dental Services | $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray) Frequency depends on type of service | $0 copay (cleaning); $0 copay (oral exam); $0 copay (dental x-ray) Frequency depends on type of service | $0 copay (cleaning); $0 copay (oral exam); $0 copay (dental x-ray) Frequency depends on type of service |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | Available for an extra premium ($25) for comprehensive dental. | Comprehensive dental included at no additional cost. | Comprehensive dental included at no additional cost. |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | $20 copay | $10 copay | $0 copay |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699 per aid | $0 copay (hearing exam) Two options available through TruHearing (up to two per year); copay from $399 per aid | $0 copay (hearing exam) $1,000 towards TruHearing-branded hearing aids every 24 months. |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More | Included | Included | Included |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| Deductible | |||
| Deductible | $0 | $0 | $0 |
| Preferred Generic | |||
| Preferred Generic | $0 copay | $0 copay | $0 copay |
| Generic | |||
| Generic | $10 copay | $10 copay | 25% or $0/$1.35/$3.95/15% Cost-sharing is based on your level of Extra Help. |
| Preferred Brand | |||
| Preferred Brand | $47 copay | $40 copay | 25% or $0/$4.00/$9.85/15% Cost-sharing is based on your level of Extra Help. |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 copay | $90 copay | 25% or $0/$4.00/$9.85/15% Cost-sharing is based on your level of Extra Help. |
| Specialty Tier | |||
| Specialty Tier | 33% of the cost | 33% of the cost | 25% or $0/$4.00/$9.85/15% Cost-sharing is based on your level of Extra Help. |
| Mail Order | |||
| Mail Order | Available | Available | Available |
| Comprehensive Dental Benefits | |||
|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Endodontics | |||
| Endodontics | $100 copay | $100 copay | $0 copay |
| Oral Surgery | |||
| Oral Surgery | $50 copay | $50 copay | $0 copay |
| Oral Pathology Biopsy | |||
| Oral Pathology Biopsy | $50 copay | $50 copay | $0 copay |
| Periodontics | |||
| Periodontics | $50 copay | $50 copay | $0 copay |
| Restorative Fillings | |||
| Restorative Fillings | $50 copay | $50 copay | $0 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 | $50 copay | $0 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) | $50 copay | $50 copay | $0 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 | $50 copay | $0 copay |
| Bridges Replacement (due to structural changes in the mouth) | |||
| Bridges Replacement (due to structural changes in the mouth) | $50 copay | $50 copay | $0 copay |
| Crowns, Inlays and Onlays Installation | |||
| Crowns, Inlays and Onlays Installation | $400 copay | $50 copay | $0 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 | $50 copay | $0 copay |
| Crowns, Inlays and Onlays Replacement | |||
| Crowns, Inlays and Onlays Replacement | $50 copay | $50 copay | $0 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) | $100 copay | $100 copay | $0 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 | $50 copay | $0 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) | $100 copay | $100 copay | $0 copay |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD Premier (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 D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550.
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) 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 $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).
Use this search tool to find doctors, hospitals, prescription drugs, and pharmacies within the Advantage MD network.
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 PPO Prescription Drughttps://www.medicareplanrx.com/jccf/Johnshopkins_formulary_21.html- An HMO Prescription Drughttps://www.medicareplanrx.com/jccf/Johnshopkins_hmo_formulary_21.html
A Pharmacyhttps://www.medicareplanrx.com/jccf/johnshopkins_pharmacy_21.html
Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Find doctors, hospitals, prescription drugs, and pharmacies within the Advantage MD network.
Explanation of Hearing Aid Coverage
Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing.
Coverage includes
- 2 hearing aids per year when purchased through TruHearing
- 3 follow-up visits with an in-network provider for fitting and adjustment of hearing aids
- 45-day trial
- 3-year manufacturer warranty for repairs and one-time loss and damage replacement
- 48 batteries per aid included with non-rechargeable models
The Silver&Fit® Exercise and Healthy Aging Program
With the Silver&Fit® Healthy Aging and Exercise program, you can choose either a fitness center membership at a participating fitness center or the Silver&Fit Home Fitness Program.
- You can join a participating Silver&Fit fitness center in our service area at no charge and take advantage of all of the services and amenities that are included as part of your basic fitness center membership.* Amenities offered by fitness centers vary by location. Any nonstandard fitness center service that typically requires an additional fee is not included in your basic fitness membership (for example, court fees or personal trainer services).
- You can switch to another participating Silver&Fit fitness center once a month and your change will be effective the first of the following month. To find a participating fitness center, you can search for the closest Silver&Fit fitness centers to you on the Silver&Fit website at www.SilverandFit.com.
- If you prefer to work out at home in lieu of a participating fitness center, you have the option to enroll in the Silver&Fit Home Fitness Program and receive up to two home fitness kits each benefit year at no charge.
- As an eligible member, you also have access to read the quarterly Silver Slate® newsletters and Healthy Aging educational materials by visiting the Silver&Fit website. Or you can request the Silver Slate newsletter and Healthy Aging Educational materials be mailed to you every quarter once you have enrolled into the Silver&Fit program.
*Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit and the Silver Slate are federally registered trademarks of ASH and used with permission herein.
Please note: the information in this section does not apply to Advantage MD Group.
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