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*, Supplemental Dental Plan and Original Medicare
| 2018 Advantage MD Plans2017 Advantage MD Plans | |||
|---|---|---|---|
| Plans & Monthly Plan Premium | |||
| Plans & Monthly Plan Premium | NEW! | | |
| 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 | $40 copay |
| Referrals | |||
| Referrals | May be required | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $45 copay | $45 copay | $40 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $250 copay | $275 copay | $200 copay |
| Emergency Care | |||
| Emergency Care | $80 copay | $80 copay | $80 copay |
| Worldwide Emergency Care | |||
| Worldwide Emergency Care | Not covered | Not covered | $80 copayment for worldwide ER visits (up to $50,000 per year outside of U.S.) |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $285/day copay for days 1-7; $0 copay for days 8 and beyond | $285/day copay for days 1-7; $0 copay for days 8 and beyond | $255/day copay for days 1-7; $0 copay for days 8 and beyond |
| 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 6 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 | $55 copay single office visit (cleaning, oral exam, dental x-ray) | $15 copay (cleaning); $15 copay (oral exam); $25 copay (dental x-ray) | $10 copay (cleaning); $10 copay (oral exam); $20 copay (dental x-ray) |
| Supplemental Dental Learn More | |||
| Supplemental Dental Learn More | Optional | Optional | Optional |
| 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 | $0 | $0 |
| Preferred Generic | |||
| Preferred Generic | $0 copay | $7 copay | $4 copay |
| Generic | |||
| Generic | $10 copay | $15 copay | $12 copay |
| Preferred Brand | |||
| Preferred Brand | $47 copay | $45 copay | $42 copay |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 copay | $95 copay | $92 copay |
| Specialty Tier | |||
| Specialty Tier | 33% of the cost | 33% of the cost | 33% 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 for 2018. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $5,900 and a combined in- and out-of-network maximum of $10,000 for 2018. 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. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurances may change on January 1 of each year.
You must continue to pay your Part B premium.
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.
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