Behind the Benefits: March 2026

The Over-the-Counter (OTC) benefit is available to members enrolled in Advantage MD HMO plans. This benefit is not included with Advantage MD PPO plans. The benefit is administered by NationsBenefits. If you are enrolled in an HMO plan and have not received your OTC card, please contact Member Services for assistance. With your NationsBenefits card, you can purchase eligible OTC items online from the NationsBenefits portal, or you can shop in-store anywhere Mastercard is accepted. So if the prices seem higher on the NationsBenefits portal, check out retail locations that may have a different selection and lower costs.

PPO: 877-293-5325
HMO: 877-293-4998

If you are unable to advocate for yourself during a hospital stay, your coverage is still protected. In an emergency, your hospital care is covered, even if it is out of our network, and you do not need prior approval. Once you are stabilized, the hospital will typically work with your health plan to coordinate your care and confirm coverage for any continued treatment. To help prepare in advance, you may want to carry your Advantage MD card with you.

We understand that your OTC benefit is an important part of how you stay healthy, and we know any reduction in this support is disappointing. This change was a difficult decision made so we could prioritize your core medical coverage and keep your monthly plan premiums as low as possible.
Recent changes in Medicare regulations, like the new lower caps on what you pay for prescription drugs, have required us to shift how we fund different benefits. Our goal is to ensure you are protected against high medical and pharmacy costs while still providing the essential health services you rely on most.

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 series.

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.

For acupuncture: Members are covered for up to 20 visits per year. Copays may apply depending on your plan.

Medicare does not cover ear molds. However, through TruHearing, Advantage MD gives members access to premium hearing aids in a variety of styles, along with follow-up provider visits and a 60-day trial period. Specific copays apply based on your plan type.

Although your prescription may not be covered, you do have the option to pay for the medication out of pocket. Please note that since the medication is not covered, the cost will not be applied toward your plan benefits. You may want to check with your pharmacy regarding pricing or available discount programs to help lower your out-of-pocket cost.

Thank you for sharing your experience and for your commitment to maintaining such a healthy and active lifestyle. We understand your question about whether individuals who actively maintain their health may qualify for lower monthly premiums. At this time, Medicare Advantage premiums are regulated by federal guidelines established by the Centers for Medicare & Medicaid Services (CMS). These guidelines require that premiums be applied uniformly to all members enrolled in the same plan, regardless of individual health status or lifestyle choices. This helps ensure fairness, prevent discrimination, and maintain equal access to coverage for all members. While we cannot adjust monthly premiums based on individual health behaviors, we do offer programs to support your healthy lifestyles. These may include wellness programs, fitness benefits, preventive care services, and incentives for completing certain health-related activities such as annual wellness visits, or screenings.

In an emergency, please seek care immediately by calling 911 or going to the nearest emergency room. You do not need prior authorization, and you are not required to use an in-network hospital. If you are taken by ambulance to an out-of-network hospital, your emergency services will be covered under your Medicare Advantage plan. This includes screening and treatment needed to stabilize your condition. After you are stabilized, additional care may need to be coordinated with the plan, and in some cases, you may be transferred to an in-network facility for ongoing treatment. 

Yes, your coverage travels with you anywhere in the United States.

Emergency care: Covered anywhere, even if the hospital is out-of-network 

Urgent care: Covered when you are temporarily away from home 

Routine care: Usually must be in-network (for HMO plans), unless your plan includes out-of-network benefits (such as a PPO) 

Telehealth & Nurse Chat: Available 24/7 at $0, wherever you are in the U.S. This is great for minor, but urgent care needs or to check if you may need to seek in-person care. You can learn more at: https://www.hopkinsmedicare.com/members/virtual-care/

If you’re planning to travel, we recommend calling Member Services in advance so we can review your benefits and help you plan.

PPO: 877-293-5325 
HMO: 877-293-4998 

Medication costs can vary. If your plan has a fixed copay for the medication tier, the price is usually the same. For medications and plans with a co-insurance, you will pay the precent of the total cost. If the drug costs is different between pharmacy locations, that cost-share will vary. Mail order is often a little less expensive. We encourage you to check the costs of medications on Caremark.com. Create an account for personalized info. We also recommend you fill a 90-day supply for mail order (100-day supply for Tier 1 for non-DSNP members).

https://jhhp.nationsbenefits.com/

Mail order is often a little less expensive. We encourage you to check the costs of medications on Caremark.com. Create an account for personalized info. We also recommend you fill a 90-day supply for mail order (100-day supply for Tier 1 for non-DSNP members). 

You are covered for emergency care worldwide. Up to a $50,000 credit every year for all covered worldwide services. If you have an emergency or urgently needed service outside the U.S. and its territories, you will be responsible for payment at the time services are rendered. You may then submit your claims and proof of payment for reimbursement consideration (minus any applicable member cost sharing). There is no coverage once you are admitted for an inpatient hospital stay.

Worldwide coverage for ‘urgently needed services’ when medical services are needed right away because of an illness, injury, or condition that you did not expect or anticipate, and you can’t wait until you are back in our plan’s service area to obtain services. Up to a $50,000 credit every year for all covered worldwide services. Please contact the plan for more details.

No, the Johns Hopkins Advantage MD over-the-counter (OTC) card cannot be used for prescription drugs. This benefit is specifically designed for health and wellness items that do not require a prescription. Prescription medications are covered separately under your plan’s Medicare Part D benefit. 

Johns Hopkins Advantage MD does not offer a “Black Card” for fitness. Instead, we a comprehensive fitness benefit through the Silver&Fit® Healthy Aging and Exercise Program at no extra cost.

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.

Absolutely! The web address is: JHHP.NationsBenefits.com. Here is a helpful guide for the portal: https://share.articulate.com/MC-L7nhAtjdPJM3HaLbWq

Johns Hopkins Health Plans is co-owned by the Johns Hopkins Health System Corporation, which is a designated 501(c)(3) not-for-profit entity, and the Johns Hopkins University School of Medicine.

It is completely understandable that 24 trips can feel limiting, especially when you live in an area without public transit and rely on these rides for your essential healthcare. The  24-trip limit is a set benefit for the calendar year, and the plan generally cannot grant “extra” trips once that limit is reached. However, for follow-up visits or consultations that don’t require a physical exam, ask your doctor if a video or phone visit is an option. This saves your transportation “credits” for the appointments where you truly need to be there in person.

We make our best efforts to establish contracts and add providers to the Advantage MD network who have an established relationship with new or existing members. We certainly can reach out to the provider with an invitation to submit an application to join our participating provider network and help facilitate any continuity of care needs you may require while the provider’s application is in review and process. It is ultimately the provider’s decision if they would like to move forward with applying to become part of our provider network. There are certain credentialing standards that all Advantage MD provider network applicants must meet to be approved as in-network providers. There are some cases where a provider applicant is not approved to join our network, but that doesn’t happen very often.