Behind the Benefits: April 2026
Answers to questions from the April 2026 member webinar with Dr. Marina Zeltser.
Questions and Responses
Are there benefits for diabetic education?
Yes, Johns Hopkins Advantage MD provides comprehensive benefits for Diabetes Self-Management Training (DSMT), Medicare Diabetes Prevention Program (MDPP), and Medical Nutrition Therapy (MNT), which are the primary services offered by diabetes educators. As a member, you have access to structured training to help you manage your condition effectively. These services are typically covered as preventive care with a $0 copay when using in-network providers. Members can attend free virtual workshops like “Managing Diabetes” and “Diabetes: A Healthier You.” You can work with a dedicated care manager who provides extra support for adopting healthy habits and bridging care between your different doctors.
Is there a cost for mail-order pharmacy?
Your cost-share for prescriptions delivered through mail order is often a little less expensive. There is no extra delivery cost for standard shipping. We encourage you to check the costs of medications on Caremark.com. Create an account for personalized info. You can use Mail Order to fill a 90-day supply of your medication (100-day supply for Tier 1 for non-DSNP members).
Are mental health services therapy sessions covered?
Mental health services are covered under Advantage MD plans. Covered providers include licensed professionals, such as psychiatrists, psychologists, clinical social workers, nurse practitioners, physician assistants, licenses professional counselors, and marriage and family therapists. Deductibles and copays may be applied depending on your plan. Prior authorizations may be required for certain services.
In addition to our core provider network, you also have access to UpLift, which is a virtual mental health practice. If you prefer or are open to virtual mental health appointments, check out UpLift. You’ll complete a basic profile and it will match you with provider options. It’s usually very quick to get an appointment – often as soon as the next day and typically no further out than two weeks.
Being new to J.H. Advantage MD care, I prefer to keep my current eye doctor and they are out-of-network. Do I need a referral from my Primary Doctor and will the bill then be approved by J.H? Thank you.
Johns Hopkins Advantage MD HMO plans only cover in-network providers. Johns Hopkins Advantage MD PPO plans do not require a referral to see an out-of-network provider. You will be subject to out-of-network cost sharing on a PPO plan. You can contact Member Services for further assistance.
Are short-term Tai Chi sessions covered? They’ve been helpful for muscles in my upper body and strengthening my neck muscles. Is acupuncture covered in lieu of costlier cortisone injections (my knee)?
Your plan covers the Silver&Fit Healthy Aging and Exercise Program at no extra cost (included in your plan). Silver&Fit allows you to take in-person classes at participating fitness centers as well as live virtual classes and on-demand workout videos. Tai Chi is part of the Silver&Fit on-demand workout options, and some fitness centers may include in-person Tai Chi classes.
Acupuncture for chronic low back pain is covered on all plans for up to 12 visits in 90 days. Some plans do cover additional acupuncture services. Please contact Member Services for further assistance.
Are dental services covered?
Preventive dental is covered on all plans. Comprehensive dental coverage varies between plans. To find out what your plan covers, please contact Member Services for further assistance.
Why doesn’t the over-the-counter medication reimbursement apply to my PPO plan?
We want to ensure you have the most reliable coverage for your essential medical needs. To help keep your monthly plan premiums affordable and comply with new Medicare requirements that lower your prescription drug costs, we had to make the difficult decision to remove the over-the-counter (OTC) benefit for 2026 from that plan. We evaluate all benefit offerings every year.
Do we need to see a different doctor for the physical and wellness visit at it overlaps?
Great question – you can see your same Primary Care Provider for a physical or the Annual Wellness Visit. We actually recommend seeing your PCP for both to build the relationship.
I got my Welcome to Medicare ekg. Why is that not offered annually?
Medicare covers the Welcome to Medicare Visit as a way to help members adjust to Medicare. It is intended to be a transition visit. After that, your plan covers an annual routine physical exam every year in addition to the Annual Wellness Visit. During that annual routine physical exam, you may receive additional services as deemed appropriate by your provider including lab tests, clinical screenings, EKG, recommendations for preventive screenings, vaccinations, and counseling about healthy behaviors.
