Understand Your Benefits
With so many benefits, it’s important to understand your Advantage MD coverage to get the most out of your health care. Use the chart below to see your benefits at-a-glance.
For specific information on your benefits, use our interactive tool to browse your covered benefits. You can also download a PDF of your plan’s summary of benefits.
Switch between Advantage MD Plans*, Optional Supplemental Benefits 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 | $5 copay | $10 copay | $5 copay |
| Specialist Visit | |||
| Specialist Visit | $50 copay | $50 copay | $50 copay |
| Referrals | |||
| Referrals | Required for Specialist Visits only | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $40 copay | $40 copay | $40 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $250 copay | $250 copay | $250 copay |
| Emergency Care | |||
| Emergency Care | $90 copay | $90 copay | $90 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 (up to $50,000 combined limit per year outside of U.S.) |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $310/day copay for days 1-6; $0 copay for days 7 to 90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-6; $0 copay for days 7 to 90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-6; $0 copay for days 7 to 90; Medicare allows 60 "lifetime reserve" days |
| Annual Routine Vision Exam | |||
| Annual Routine Vision Exam | $0 copay once per year; up to $150 allowance for eyewear every two years | $0 copay once per year | $0 copay once per year; up to $150 allowance for 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 | Not covered | Not covered | $200 annual allowance |
| Preventive Dental Services | |||
| Preventive Dental Services | $15 copay (cleaning); $15 copay (oral exam); $25 copay (dental x-ray) Each service once per year | $15 copay (cleaning); $15 copay (oral exam); $25 copay (dental x-ray) Each service once per year | $10 copay (cleaning); $10 copay (oral exam); $20 copay (dental x-ray) Each service twice per year |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | Available for an extra premium ($32) for comprehensive dental and fitness. | Available for an extra premium ($32) for comprehensive dental and fitness. | Available for an extra premium ($28) for comprehensive dental. |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | Not covered | Not covered | $20 copay (up to 12 times per year) |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | Two options available through TruHearing (up to two per year); copay from $699 per aid | Two options available through TruHearing (up to two per year); copay from $699 per aid | 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 | N/A | N/A | Included |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | |||
| Deductible | |||
| Deductible | $0 | $350 (applies to tiers 3, 4 and 5) | $350 (applies to tiers 3, 4 and 5) |
| Preferred Generic | |||
| Preferred Generic | $0 copay | $7 copay | $4 copay |
| Generic | |||
| Generic | $10 copay | $15 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 | 26% of the cost | 26% of the cost |
| Mail Order Learn More | |||
| Mail Order Learn More | Available | Available | Available |
*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. 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. Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $6,700.
For out-of-network benefits, you pay a percentage for most covered services.
This information is not a complete description of benefits. Call 1-888-403-7682 (TTY: 711) for more information.
Our Service Area
Advantage MD offers three plans for Medicare-eligible residents in 12 counties including Baltimore City. See the map below for our service area.
Going Out-of-Network
As a member of our PPO or Plus PPO plan, you can choose to receive care from out-of-network providers. These plans will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary. For more information about cost-sharing for out-of-network providers, please refer to the Medical Benefits chart in Chapter 4 of your plan’s EOC.
As a member of our HMO plan, you must use in-network providers to get your medical care and services. Care you receive from an out-of-network provider will not be covered. The only exceptions are emergencies, urgently needed services in which the network is not available (generally, when you are out of the area), out-of-area dialysis, and in cases in which Johns Hopkins Advantage MD (HMO) authorizes use of out of network providers. For more information about the network, please refer to Chapter 3 of your plan’s EOC.
Explanation of Hearing Aid Coverage
Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. The hearing aid models feature smartphone compatibility, the latest digital signal processing technology, a variety of colors and styles, a high power option, and more.
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
Copayments
- Advanced 19: $699 per aid
- Premium 19: $999 per aid
- Initial hearing exam: $0
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.
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