Behind the Benefits: February 2026
Answers to questions from the Feb. 27, 2026 member webinar with Lori Rund, Vice President of Medicare Advantage.
Questions and Responses
During the session, members asked a variety of questions about benefits, prescription coverage, supplemental services, and more. To make this information easy to review, we’ve compiled the questions submitted during the event and provided answers below.
Browse Questions by Topic
OTC (Over the Counter) Benefits
How much is the OTC allowance?
OTC allowances for 2026 vary by plan, as noted below. If a plan is not listed, it does not have an OTC allowance for 2026.
- Advantage MD HMO: $30 per quarter
- Advantage MD D-SNP: $50 per quarter
- Advantage MD Tribute (HMO): $35 per quarter
- Advantage MD Select (HMO): $50 per quarter
The plan year quarters are broken down as January through March; April through June; July through September; and October through December. Unused funds do not roll over to the next quarter.
Why was the OTC benefit reduced or removed for PPO members?
Advantage MD offers different types of plans so members can select the benefit package and coverage that best meets their needs and preferences. Benefits vary by plan type. Each year, we review benefits to keep each plan type competitive and affordable. In order to offer other benefits, including out-of-network coverage and lower cost shares on certain services, some supplemental benefits may change year over year.
Why was CVS Caremark OTC removed?
Advantage MD’s OTC benefit is now provided through NationsBenefits, which offers more flexibility on where the OTC allowance can be used. Members are now able to shop at more retail locations, in addition to CVS, and are not restricted to CVS-only brands. Additionally, coupons and store discounts can also be applied where accepted.
Will you raise the OTC back to $60?
We review benefits each year. We appreciate your feedback and will consider it in future benefit planning.
How does the OTC Mastercard work?
Your OTC funds are loaded onto your OTC card each quarter. You can use the card at participating stores for eligible items. Prior to shopping, confirm:
- Items are OTC-eligible
- You have available funds
- The store accepts Mastercard
Can I use any pharmacy, including Costco?
You may use participating retailers that accept Mastercard. Costco only accepts Visa, which may cause issues at checkout. To prevent transaction issues, please enter the pin code “0000” when prompted.
Annual Wellness Visit
Is the Annual Wellness Visit the same as a regular checkup?
The Annual Wellness Visit focuses on prevention. It includes:
- Reviewing your health history
- Updating your personalized prevention plan
- Discussing screenings and fall risk
It does not typically include labs or treatment for new medical concerns. If you and your provider discuss a health concern that is outside the scope of an Annual Wellness Visit, the provider office may bill for that separately.
Consider using our Annual Wellness Visit checklist to guide your visit and stay within the visit’s coverage. Tell your doctor at the start of the visit if you want to make sure the visit does not result in any additional charges. It may also be helpful to ask your doctor, “If we talk about [other health concern], will it be billed as an addition to this Annual Wellness Visit?” You and your provider may agree to schedule a separate appointment to discuss other health concerns.
Is it the same as the “Welcome to Medicare” visit?
No, these are actually two separate services that members can have. The Welcome to Medicare visit is covered for members who are new to Medicare — within the first 12 months of their enrollment with Medicare Part B. The Annual Wellness Visit occurs once every 12 months after that. New Medicare members can have both a Welcome to Medicare visit and an Annual Wellness Visit.
Prescription & Pharmacy Questions
Do prescriptions now have a 100-day supply?
Some medications may qualify for extended supplies, depending on your plan and pharmacy. For most plans, using mail order, you can order up to a 100-day supply of medications on Tier 1 and a 90-day supply of medications on Tier 2 through 4. Drugs in Tier 5 are only available for 30-day supplies. D-SNP members can fill all prescriptions for 90-day supplies. Please confirm your specific coverage for your specific drugs with Member Services at PPO: 877-293-5328 or HMO: 8877-293-4998 (TTY: 711) to learn more about or purchase the comprehensive dental coverage for 2026.
If I order drugs online, is it cheaper?
Mail-order pharmacies may offer cost savings for certain medications, especially for 90-day supplies. Please check with Member Services at PPO: 877-293-5328 or HMO: 877-293-4998 (TTY: 711) to confirm.
Why doesn’t Hopkins pay for scheduled medications?
Coverage depends on your plan formulary and Medicare guidelines. If you have a specific medication question, Member Services can review it with you. Call PPO: 877-293-5328 or HMO: 877-293-4998 (TTY: 711)
Transportation
Why is transportation only for HMO plans?
Transportation is included in certain HMO plans as part of their benefit structure. In order to offer other benefits, including out-of-network coverage and lower cost shares on certain services, some supplemental benefits for PPO plans may change year over year.
How do I schedule return transportation if I don’t know when my appointment ends?
You can schedule a return window time or call NationsBenefits when your appointment is finished. If you have any questions about the timing of your rides or scheduling pick-ups, call 888-959-2069 (TTY: 711), 8 a.m. – 8 p.m.
Referrals & Network
Are referrals needed this year?
HMO plans do not require referrals for in-network specialists. PPO members can see specialists without referrals but may pay more for out-of-network providers.
What is in-network vs. out-of-network?
In-network: Providers contracted with your plan (lower costs).
Out-of-network (PPO only): Providers are not contracted; for PPO plans, visits with out-of-network providers are allowed, but typically covered at a higher cost share. For example, the PPO plan covers a PCP visit with an in-network provider at a $5 copay, while a PCP visit with an out-of-network provider is covered at 40% co-insurance.
Traveling Out of State
If I am visiting California and it’s not urgent, what can I do?
For non-emergency care while traveling, you may:
- Use telehealth services
- Call the 24/7 Nurse Chat line: 888-202-8828 (TTY:711)
Dental Network
Will dental providers be expanded?
We continually evaluate our provider network and work with DentaQuest to improve dental access in the counties we serve. We appreciate your feedback and encourage you to call Member Services at PPO: 877-293-5325 or HMO: 877-293-4998 (TTY: 711) if you need assistance with finding a dentist.
Billing & Payment
I owe $26 due to a lapse. Can I pay online?
No, we currently do not have an online payment option. You may contact Member Services at PPO: 877-293-5325 or HMO: 877-293-4998 (TTY: 711) to discuss payment options.
Plan & Enrollment
Is Hopkins Medicare the same as Johns Hopkins Advantage MD?
Yes. Johns Hopkins Advantage MD is the Medicare Advantage plan offered by Johns Hopkins Health Plans. Some people may refer to it as “Hopkins Medicare.”
