Understand Your 2023 Benefits
Looking for 2022 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.
Select a county below to see the chart that applies to you:
Switch between Advantage MD HMO Plans* and 2022 Original Medicare
| Advantage MD HMO 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 | $0 copay | $20 copay | 20% |
| Specialist Visit | |||
| Specialist Visit | $45 copay | $50 copay | 20% |
| Referrals | |||
| Referrals | Required for Specialist Visits only | Required for Specialist Visits only | Required for Specialist Visits only |
| Urgent Care | |||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. | 20% |
| Telemedicine | |||
| Telemedicine | $0 copay | $0 copay | $0 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $225 copay | $250 copay | $0 copay |
| Emergency Care | |||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $95 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | 20% |
| Worldwide Emergency & Urgently Needed Services | |||
| Worldwide Emergency & Urgently Needed Services | Not covered | Not covered | Not covered |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $350/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | 20% |
| Vision Benefits | |||
| Vision Benefits | $50 copay once per year; up to $150 allowance for additional eyewear every year | $0 copay once per year; up to $400 allowance for additional eyewear every two years | Routine eye exam (1 every year): You pay nothing Eyeglasses or contact lenses after cataract surgery: You pay nothing Routine eyewear: Our plan pays up to $400 every two years for supplemental eyewear (retail or online) from any provider. |
| Routine Podiatry Services | |||
| Routine Podiatry Services | 20% | Not covered | $0 for 12 visits |
| Acupuncture | |||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain | Medicare-covered acupuncture: You pay nothing Non-Medicare covered acupuncture: Not covered |
| Preventive Dental Services | |||
| Preventive Dental Services | Medicare-covered dental services: 20% coinsurance Preventive dental services: Cleaning(s) (1 cleaning per year): $20 copay | Medicare-covered dental services: You pay nothing Preventive dental services: Cleaning(s) (2 cleanings per year): You pay nothing | Medicare-covered dental services: You pay nothing |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | $25 | Not available | Not available |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | Medicare-covered chiropractic care: $20 copay Non-Medicare covered chiropractic care: Not covered | Medicare-covered chiropractic care: $10 copay Non-Medicare covered chiropractic care: Not covered | Medicare-covered chiropractic care: You pay nothing Non-Medicare covered chiropractic care (12 routine chiropractic visits per year): You pay nothing |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699-$999 per aid | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $399-$699 per aid | The plan pays a maximum benefit amount of $1,000 towards the purchase of hearing aids every 24 months. You pay all costs after the $1,000 maximum benefit amount for TruHearing-branded hearing aids. |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. |
| 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 for a one-month supply $0 for a two-month supply $0 for a three-month supply | Not Available | For generic drugs (including brand drugs treated as a generic), you pay either: $0/$1.45/$4.15/15%* For all other drugs, you pay either: $0/$4.30/$10.35/15%* Cost-sharing is based on your level of Extra Help. |
| Generic | |||
| Generic | $10 for a one-month supply $15 for a two-month supply $20 for a three-month supply | Not Available | For generic drugs (including brand drugs treated as a generic), you pay either: $0/$1.45/$4.15/15%* For all other drugs, you pay either: $0/$4.30/$10.35/15%* Cost-sharing is based on your level of Extra Help. |
| Preferred Brand | |||
| Preferred Brand | $47 ($35 for Select Insulins) for a one-month supply $70.50 ($52.50 for select insulins) for a two-month supply $94 ($70 for Select Insulins) for a three-month supply | Not Available | For generic drugs (including brand drugs treated as a generic), you pay either: $0/$1.45/$4.15/15%* For all other drugs, you pay either: $0/$4.30/$10.35/15%* Cost-sharing is based on your level of Extra Help. |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | Not Available | For generic drugs (including brand drugs treated as a generic), you pay either: $0/$1.45/$4.15/15%* For all other drugs, you pay either: $0/$4.30/$10.35/15%* Cost-sharing is based on your level of Extra Help. |
| Specialty Tier | |||
| Specialty Tier | 33% of the total cost of a one-month supply (long-term supply is not available) | Not Available | For generic drugs (including brand drugs treated as a generic), you pay either: $0/$1.45/$4.15/15%* For all other drugs, you pay either: $0/$4.30/$10.35/15%* Cost-sharing is based on your level of Extra Help. |
| Mail Order | |||
| Mail Order | Available | Not Available | Available |
| Comprehensive Dental Benefits | |||
|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Endodontics | |||
| Endodontics | $100 copay | In-network: You pay nothing | You pay nothing |
| Oral Surgery | |||
| Oral Surgery | $50 | $0 | $0 |
| Oral Pathology Biopsy | |||
| Oral Pathology Biopsy | $50 | $0 | $0 |
| Periodontics | |||
| Periodontics | In-network & Out-of-network: $50 copay | In-network: You pay nothing | You pay nothing |
| Restorative Fillings | |||
| Restorative Fillings | $50 | $0 | $0 |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | |||
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | $50 | $0 | $0 |
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | $100 | $0 | $0 |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | |||
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | $50 | $0 | $0 |
| Bridges Replacement (due to structural changes in the mouth) | |||
| Bridges Replacement (due to structural changes in the mouth) | $50 | $0 | $0 |
| Crowns, Inlays and Onlays Installation | |||
| Crowns, Inlays and Onlays Installation | In-network & Out-of-network: $50 copay | In-network: You pay nothing | You pay nothing |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | |||
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | In-network & Out-of-network: $50 copay | In-network: You pay nothing | You pay nothing |
| Crowns, Inlays and Onlays Replacement | |||
| Crowns, Inlays and Onlays Replacement | In-network & Out-of-network: $50 copay | In-network: You pay nothing | You pay nothing |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing | You pay nothing |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | |||
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing | You pay nothing |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | |||
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing | You pay nothing |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD Premier (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550.
For out-of-network benefits, you pay a percentage for most covered services.
Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Premier (PPO) plan has a $1,500 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $500 Annual Maximum.
Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).
Switch between Advantage MD HMO Plans* and 2022 Original Medicare
| Advantage MD PPO Plans | ||
|---|---|---|
| Plans & Monthly Plan Premium | ||
| Plans & Monthly Plan Premium | Johns Hopkins | Johns Hopkins |
| MEDICAL BENEFITS (partial listing: in-network) | ||
| MEDICAL BENEFITS (partial listing: in-network) | ||
| Medical Deductible | ||
| Medical Deductible | $0 | $0 |
| Primary Care Provider Visit | ||
| Primary Care Provider Visit | $0 copay | $20 copay |
| Specialist Visit | ||
| Specialist Visit | $45 copay | $50 copay |
| Referrals | ||
| Referrals | Required for Specialist Visits only | Required for Specialist Visits only |
| Urgent Care | ||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. |
| Telemedicine | ||
| Telemedicine | You pay nothing | You pay nothing |
| Ambulatory Surgical Centers Outpatient Surgery | ||
| Ambulatory Surgical Centers Outpatient Surgery | $5 copay | $250 copay |
| Emergency Care | ||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | $95 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. |
| Worldwide Emergency & Urgently Needed Services | ||
| Worldwide Emergency & Urgently Needed Services | Not covered | Not covered |
| Inpatient Hospital Stay | ||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $350/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days |
| Vision Benefits | ||
| Vision Benefits | $50 copay once per year; up to $150 allowance for additional eyewear every year | $50 copay once per year; up to $300 allowance for additional eyewear every two years |
| Routine Podiatry Services | ||
| Routine Podiatry Services | 20% | Not covered |
| Acupuncture | ||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain |
| Preventive Dental Services | ||
| Preventive Dental Services | Medicare-covered dental services: 20% coinsurance Preventive dental services: Cleaning(s) (1 cleaning per year): $20 copay | Medicare-covered dental services: You pay nothing Preventive dental services: Cleaning(s) (2 cleanings per year): You pay nothing |
| Optional Supplemental Benefits Learn More | ||
| Optional Supplemental Benefits Learn More | $25 | Not available |
| Routine Chiropractic Services | ||
| Routine Chiropractic Services | Medicare-covered chiropractic care: $20 copay Non-Medicare covered chiropractic care: Not covered | Medicare-covered chiropractic care: $10 copay Non-Medicare covered chiropractic care: Not covered |
| Hearing Aid Services Learn More | ||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699-$999 per aid | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $399-$699 per aid |
| Silver&Fit® Program Learn More | ||
| Silver&Fit® Program Learn More | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||
| Deductible | ||
| Deductible | $0 | $0 |
| Preferred Generic | ||
| Preferred Generic | $0 for a one-month supply $0 for a two-month supply $0 for a three-month supply | Not Available |
| Generic | ||
| Generic | $20 for a one-month supply $30 for a two-month supply $40 for a three-month supply | Not Available |
| Preferred Brand | ||
| Preferred Brand | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply | Not Available |
| Non-Preferred Drug | ||
| Non-Preferred Drug | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | Not Available |
| Specialty Tier | ||
| Specialty Tier | 33% of the total cost of a one-month supply (long-term supply is not available) | Not Available |
| Mail Order | ||
| Mail Order | Available | Not Available |
| Comprehensive Dental Benefits | ||
|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| Endodontics | ||
| Endodontics | Not Available | In-network: You pay nothing |
| Oral Surgery | ||
| Oral Surgery | $50 | $0 |
| Oral Pathology Biopsy | ||
| Oral Pathology Biopsy | $50 | $0 |
| Periodontics | ||
| Periodontics | In-network & Out-of-network: $50 copay | In-network: You pay nothing |
| Restorative Fillings | ||
| Restorative Fillings | $50 | $0 |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | ||
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | $50 | $0 |
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | ||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | $100 | $0 |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | ||
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | $50 | $0 |
| Bridges Replacement (due to structural changes in the mouth) | ||
| Bridges Replacement (due to structural changes in the mouth) | $50 | $0 |
| Crowns, Inlays and Onlays Installation | ||
| Crowns, Inlays and Onlays Installation | In-network & Out-of-network: $50 copay | In-network: You pay nothing |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | ||
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | In-network & Out-of-network: $50 copay | In-network: You pay nothing |
| Crowns, Inlays and Onlays Replacement | ||
| Crowns, Inlays and Onlays Replacement | In-network & Out-of-network: $50 copay | In-network: You pay nothing |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | ||
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | ||
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | ||
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300.
For out-of-network benefits, you pay a percentage for most covered services.
Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum.
Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).
Switch between Advantage MD Plans* and 2022 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 | This plan does not have any medical deductibles. | This plan does not have any medical deductibles. | This plan does not have any medical deductibles. |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | $0 copay | In-network: $5 Out-of-network: 40% coinsurance | In-network: You pay nothing Out-of-network: 30% coinsurance |
| Specialist Visit | |||
| Specialist Visit | $45 copay | In-network: $50 copay Out-of-network: 40% coinsurance | In-network: $40 copay Out-of-network: 30% coinsurance |
| Referrals | |||
| Referrals | Required for Specialist Visits only | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. |
| Telemedicine | |||
| Telemedicine | $0 copay | $0 copay | $0 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | $225 copay | In-network: $225 copay Out-of-network: 50% coinsurance | In-network: $225 copay Out-of-network: 30% coinsurance |
| Emergency Care | |||
| Emergency Care | $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | In-network & Out-of-network: $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | In-network & Out-of-network: $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. |
| Worldwide Emergency & Urgently Needed Services | |||
| Worldwide Emergency & Urgently Needed Services | Not covered | $95 copayment for Emergency Care and $40 copayment for Urgently Needed Services | $90 copayment for Emergency Care and $40 copayment for Urgently Needed Services |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $325/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days |
| Vision Benefits | |||
| Vision Benefits | $50 copay once per year; up to $150 allowance for additional eyewear every year | $50 copay once per year; up to $300 allowance for additional eyewear every year | $40 copay once per year; up to $150 allowance for additional eyewear every year |
| Routine Podiatry Services | |||
| Routine Podiatry Services | 20% | 20% | 20% |
| Acupuncture | |||
| Acupuncture | 20% coinsurance for chronic lower back pain | Medicare-covered acupuncture: In-network: 20% coinsurance Out-of-network: 30% coinsurance Non-Medicare covered acupuncture: Not covered | Medicare-covered acupuncture: In-network: 20% coinsurance Out-of-network: 30% coinsurance Non-Medicare covered acupuncture: In-network & Out-of-network: Our plan will pay up to $200 annually for services. |
| Preventive Dental Services | |||
| Preventive Dental Services | Medicare-covered dental services: 20% coinsurance Preventive dental services: Cleaning(s) (1 cleaning per year): $20 copay | (2 cleanings per year): In-network: You pay nothing Out-of-network: 50% coinsurance | (2 cleanings per year): In-network: You pay nothing Out-of-network: 30% coinsurance |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | $25 | Not Available | Available for an extra premium ($25) for comprehensive dental. |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | Medicare-covered chiropractic care: $20 copay Non-Medicare covered chiropractic care: Not covered | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 50% coinsurance | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 30% coinsurance |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | $0 copay (hearing exam) Two hearing aid options available through TruHearing (up to two per year); copay from $699-$999 per aid | Routine hearing exam: In-network: You pay nothing (one routine hearing exam per year from a TruHearing provider.) Out-of-network: 50% coinsurance In-network & Out-of-network: You pay a $699 copay per aid for Advanced hearing aids or $999 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year). | Routine hearing exam: In-network: You pay nothing (one routine hearing exam per year from a TruHearing provider.) Out-of-network: 30% coinsurance In-network & Out-of-network: You pay a $699 copay per aid for Advanced hearing aids or $999 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year). |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More | You pay nothing at participating fitness centers | You pay nothing at participating fitness centers | You pay nothing at participating fitness centers |
| 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 for a one-month supply $0 for a two-month supply $0 for a three-month supply | $4 for a one-month supply $6 for a two-month supply $8 for a three-month supply | $4 for a one-month supply $6 for a two-month supply $8 for a three-month supply |
| Generic | |||
| Generic | $10 for a one-month supply $15 for a two-month supply $20 for a three-month supply | $12 for a one-month supply $18 for a two-month supply $24 for a three-month supply | $12 for a one-month supply $18 for a two-month supply $24 for a three-month supply |
| Preferred Brand | |||
| Preferred Brand | $47 ($35 for Select Insulins) for a one-month supply $70.50 ($52.50 for select insulins) for a two-month supply $94 ($70 for Select Insulins) for a three-month supply | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply |
| Specialty Tier | |||
| Specialty Tier | 33% of the total cost of a one-month supply (long-term supply is not available) | 33% of the total cost of a one-month supply (long-term supply is not available) | 33% of the total cost of a one-month supply (long-term supply is not available) |
| Mail Order | |||
| Mail Order | Available | Available | Available |
| Comprehensive Dental Benefits | |||
|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Endodontics | |||
| Endodontics | $100 copay | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Oral Surgery | |||
| Oral Surgery | $50 | $0 | $50 |
| Oral Pathology Biopsy | |||
| Oral Pathology Biopsy | $50 | $0 | $50 |
| Periodontics | |||
| Periodontics | In-network & Out-of-network: $50 copay | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Restorative Fillings | |||
| Restorative Fillings | $50 | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | |||
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | $50 | $0 | $50 |
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | $100 | $0 | $100 |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | |||
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | $50 | $0 | $50 |
| Bridges Replacement (due to structural changes in the mouth) | |||
| Bridges Replacement (due to structural changes in the mouth) | $50 | $0 | $50 |
| Crowns, Inlays and Onlays Installation | |||
| Crowns, Inlays and Onlays Installation | In-network & Out-of-network: $50 copay | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | |||
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | In-network & Out-of-network: $50 copay | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Crowns, Inlays and Onlays Replacement | |||
| Crowns, Inlays and Onlays Replacement | In-network & Out-of-network: $50 copay | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | |||
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | |||
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | In-network & Out-of-Network: $50-$100 copay depending on the service | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300.
For out-of-network benefits, you pay a percentage for most covered services.
Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum.
Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).
Switch between Advantage MD PPO Plans* and 2022 Original Medicare
| Advantage MD PPO 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 | $800 | This plan does not have any medical deductibles. | This plan does not have any medical deductibles. |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | In-network: You pay nothing Out-of-network: 30% coinsurance | In-network: $5 Out-of-network: 40% coinsurance | In-network: You pay nothing Out-of-network: 30% coinsurance |
| Specialist Visit | |||
| Specialist Visit | In-network: $40 copay Out-of-network: 30% coinsurance | In-network: $50 copay Out-of-network: 40% coinsurance | In-network: $40 copay Out-of-network: 30% coinsurance |
| Referrals | |||
| Referrals | Not required | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. | $40 copay The copay is not waived if you are admitted to the hospital. |
| Telemedicine | |||
| Telemedicine | $0 copay | $0 copay | $0 copay |
| Ambulatory Surgical Centers Outpatient Surgery | |||
| Ambulatory Surgical Centers Outpatient Surgery | In-network: $225 copay Out-of-network: 30% coinsurance | In-network: $225 copay Out-of-network: 50% coinsurance | In-network: $225 copay Out-of-network: 30% coinsurance |
| Emergency Care | |||
| Emergency Care | In-network & Out-of-network: $95 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | In-network & Out-of-network: $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | In-network & Out-of-network: $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. |
| Worldwide Emergency & Urgently Needed Services | |||
| Worldwide Emergency & Urgently Needed Services | $95 copayment for Emergency Care and $40 copayment for Urgently Needed Services | Emergency care is covered worldwide. | Emergency care is covered worldwide. |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $350/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $310/day copay for days 1-6; $0 copay for days 7-90; Medicare allows 60 "lifetime reserve" days |
| Vision Benefits | |||
| Vision Benefits | $50 copay once per year; up to $200 allowance for additional eyewear every year | In-network: $50 copay Out-of-network: 50% coinsurance | In-network: $40 copay Out-of-network: 30% coinsurance |
| Routine Podiatry Services | |||
| Routine Podiatry Services | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain. $200 supplemental benefit for any injury or illness. |
| Acupuncture | |||
| Acupuncture | Medicare-covered acupuncture: In-network: 20% coinsurance Out-of-network: 30% coinsurance Non-Medicare covered acupuncture: Not covered | Medicare-covered acupuncture: In-network: 20% coinsurance Out-of-network: 30% coinsurance Non-Medicare covered acupuncture: Not covered | Medicare-covered acupuncture: In-network: 20% coinsurance Out-of-network: 30% coinsurance Non-Medicare covered acupuncture: In-network & Out-of-network: Our plan will pay up to $200 annually for services. |
| Preventive Dental Services | |||
| Preventive Dental Services | (2 cleanings per year): In-network: You pay nothing Out-of-network: 50% coinsurance | (2 cleanings per year): In-network: You pay nothing Out-of-network: 50% coinsurance | (2 cleanings per year): In-network: You pay nothing Out-of-network: 30% coinsurance |
| Optional Supplemental Benefits Learn More | |||
| Optional Supplemental Benefits Learn More | Not Available | Not Available | $25 |
| Routine Chiropractic Services | |||
| Routine Chiropractic Services | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 30% coinsurance | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 50% coinsurance | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 30% coinsurance |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More | Not Covered | Routine hearing exam: In-network: You pay nothing (one routine hearing exam per year from a TruHearing provider.) Out-of-network: 50% coinsurance In-network & Out-of-network: You pay a $699 copay per aid for Advanced hearing aids or $999 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year). | Routine hearing exam: In-network: You pay nothing (one routine hearing exam per year from a TruHearing provider.) Out-of-network: 30% coinsurance In-network & Out-of-network: You pay a $699 copay per aid for Advanced hearing aids or $999 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year). |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. |
| 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 | $5 for a one-month supply $7.50 for a two-month supply $10 for a three-month supply | $4 for a one-month supply $6 for a two-month supply $8 for a three-month supply | $4 for a one-month supply $6 for a two-month supply $8 for a three-month supply |
| Generic | |||
| Generic | $20 for a one-month supply $30 for a two-month supply $40 for a three-month supply | $12 for a one-month supply $18 for a two-month supply $24 for a three-month supply | $12 for a one-month supply $18 for a two-month supply $24 for a three-month supply |
| Preferred Brand | |||
| Preferred Brand | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply |
| Specialty Tier | |||
| Specialty Tier | 33% of the total cost of a one-month supply (long-term supply is not available) | 33% of the total cost of a one-month supply (long-term supply is not available) | 33% of the total cost of a one-month supply (long-term supply is not available) |
| Mail Order | |||
| Mail Order | Available | Available | Available |
| Comprehensive Dental Benefits | |||
|---|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Endodontics | |||
| Endodontics | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Oral Surgery | |||
| Oral Surgery | $0 | $0 | $50 |
| Oral Pathology Biopsy | |||
| Oral Pathology Biopsy | $0 | $0 | $50 |
| Periodontics | |||
| Periodontics | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Restorative Fillings | |||
| Restorative Fillings | $0 | $50 | In-network & Out-of-network: $50 copay |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | |||
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | $0 | $50 | $50 |
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | $0 | $100 | $100 |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | |||
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | $0 | $50 | $50 |
| Bridges Replacement (due to structural changes in the mouth) | |||
| Bridges Replacement (due to structural changes in the mouth) | $0 | $50 | $50 |
| Crowns, Inlays and Onlays Installation | |||
| Crowns, Inlays and Onlays Installation | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | |||
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Crowns, Inlays and Onlays Replacement | |||
| Crowns, Inlays and Onlays Replacement | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50 copay |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | |||
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | |||
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | |||
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: $50-$100 copay depending on the service |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300.
For out-of-network benefits, you pay a percentage for most covered services.
Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum.
Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).
Switch between Advantage MD HMO Plans* and 2022 Original Medicare
| Advantage MD PPO Plans | ||
|---|---|---|
| Plans & Monthly Plan Premium | ||
| Plans & Monthly Plan Premium | Johns Hopkins | Johns Hopkins |
| MEDICAL BENEFITS (partial listing: in-network) | ||
| MEDICAL BENEFITS (partial listing: in-network) | ||
| Medical Deductible | ||
| Medical Deductible | $800 | Not included |
| Primary Care Provider Visit | ||
| Primary Care Provider Visit | $0 copay | $0 copay |
| Specialist Visit | ||
| Specialist Visit | $40 copay | $25 copay |
| Referrals | ||
| Referrals | Not required | Not required |
| Urgent Care | ||
| Urgent Care | $50 copay The copay is not waived if you are admitted to the hospital. | $20 copay The copay is not waived if you are admitted to the hospital. |
| Telemedicine | ||
| Telemedicine | $0 copay | $0 copay |
| Ambulatory Surgical Centers Outpatient Surgery | ||
| Ambulatory Surgical Centers Outpatient Surgery | In-network: $225 copay Out-of-network: 30% coinsurance | In-network & Out-of-network: $100 copay |
| Emergency Care | ||
| Emergency Care | In-network & Out-of-network: $95 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. | In-network & Out-of-network: $90 copay The copay is waived if you are admitted to the hospital within 24 hours for the same condition. |
| Worldwide Emergency & Urgently Needed Services | ||
| Worldwide Emergency & Urgently Needed Services | Emergency care is covered worldwide. | Emergency care is covered worldwide. |
| Inpatient Hospital Stay | ||
| Inpatient Hospital Stay | $350/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days | $200/day copay for days 1-5; $0 copay for days 6-90; Medicare allows 60 "lifetime reserve" days |
| Vision Benefits | ||
| Vision Benefits | In-network: $10 copay Out-of-network: 30% coinsurance | In-network & Out-of-network: $10 copay |
| Routine Podiatry Services | ||
| Routine Podiatry Services | Not covered | $10 |
| Acupuncture | ||
| Acupuncture | 20% coinsurance for chronic lower back pain | 20% coinsurance for chronic lower back pain. $300 supplemental benefit for any injury or illness. |
| Preventive Dental Services | ||
| Preventive Dental Services | (2 cleanings per year): In-network: You pay nothing Out-of-network: 50% coinsurance | Cleaning(s) (2 cleanings per year): In-network & Out-of-network: You pay nothing |
| Optional Supplemental Benefits Learn More | ||
| Optional Supplemental Benefits Learn More | Not available | Not available |
| Routine Chiropractic Services | ||
| Routine Chiropractic Services | Medicare-covered chiropractic care: In-network: $20 copay Out-of-network: 30% coinsurance Non-Medicare covered chiropractic care: Not covered | Medicare-covered chiropractic care: In-network & Out-of-network: $10 copay Non-Medicare covered chiropractic care: (up to 12 visits per calendar year) In-network & Out-of-network: $10 copay |
| Hearing Aid Services Learn More | ||
| Hearing Aid Services Learn More | Not covered | Routine hearing exam: In-network & Out-of-network: You pay nothing In-network & Out-of-network: You pay a $399 copay per aid for Advanced hearing aids or $699 copay per aid for Premium hearing aids for up to two TruHearing-branded hearing aids every year (one per ear per year). |
| Silver&Fit® Program Learn More | ||
| Silver&Fit® Program Learn More | You pay nothing at participating fitness centers. | You pay nothing at participating fitness centers. |
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||
| PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy) | ||
| Deductible | ||
| Deductible | $0 | $0 |
| Preferred Generic | ||
| Preferred Generic | $5 for a one-month supply $7.50 for a two-month supply $10 for a three-month supply | $0 for a one-month supply $0 for a two-month supply $0 for a three-month supply |
| Generic | ||
| Generic | $20 for a one-month supply $30 for a two-month supply $40 for a three-month supply | $10 for a one-month supply $15 for a two-month supply $20 for a three-month supply |
| Preferred Brand | ||
| Preferred Brand | $47 ($35 for Select Insulins) for a one-month supply $94 ($70 for select insulins) for a two-month supply $141 ($105 for Select Insulins) for a three-month supply | $40 ($35 for Select Insulins) for a one-month supply $80 ($70 for select insulins) for a two-month supply $120 ($105 for Select Insulins) for a three-month supply |
| Non-Preferred Drug | ||
| Non-Preferred Drug | $100 for a one-month supply $200 for a two-month supply $300 for a three-month supply | $90 for a one-month supply $180 for a two-month supply $270 for a three-month supply |
| Specialty Tier | ||
| Specialty Tier | 33% of the total cost of a one-month supply (long-term supply is not available) | 33% of the total cost of a one-month supply (long-term supply is not available) |
| Mail Order | ||
| Mail Order | Available | Available |
| Comprehensive Dental Benefits | ||
|---|---|---|
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| BASIC RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| Endodontics | ||
| Endodontics | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Oral Surgery | ||
| Oral Surgery | $0 | $0 |
| Oral Pathology Biopsy | ||
| Oral Pathology Biopsy | $0 | $0 |
| Periodontics | ||
| Periodontics | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Restorative Fillings | ||
| Restorative Fillings | $50 copayIn-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | ||
| General Anesthesia (when medically necessary and administered in connection with oral or dental surgery) | $0 | $0 |
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher | ||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | ||
| Bridges Installation or Addition (due to the covered extraction of one or more natural teeth) | $0 | $0 |
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | ||
| Bridges Adjustment or Repair (due to the covered extraction of one or more natural teeth) | $0 | $0 |
| Bridges Replacement (due to structural changes in the mouth) | ||
| Bridges Replacement (due to structural changes in the mouth) | $0 | $0 |
| Crowns, Inlays and Onlays Installation | ||
| Crowns, Inlays and Onlays Installation | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | ||
| Crowns, Inlays and Onlays Adjustment or Repair (more than six months after installation) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Crowns, Inlays and Onlays Replacement | ||
| Crowns, Inlays and Onlays Replacement | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | ||
| Dentures (full or partial) Installation or Addition (due to the covered extraction of one or more natural teeth) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | ||
| Dentures (full or partial) Adjustment or Repair (more than six months after installation) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | ||
| Dentures (full or partial) Replacement of Full Denture (due to structural changes in the mouth) | In-network: You pay nothing Out-of-network: 50% coinsurance | In-network & Out-of-network: You pay nothing |
*Please note: this information does not apply to Advantage MD Group.
Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300.
For out-of-network benefits, you pay a percentage for most covered services.
Limitations: 1. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 2. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum.
Prior authorizations are required for the following: endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full or partial).
Our Service AreaCollapse
Advantage MD offers plans for Medicare-eligible residents in 10 counties. See the map below for our service area.
The Johns Hopkins Advantage MD (HMO) service area includes the following counties in Maryland: Anne Arundel, Baltimore, Carroll, Frederick, Howard, Montgomery, Somerset, Washington, Wicomico, and Worcester.
The Johns Hopkins Advantage MD (PPO) and Johns Hopkins Advantage MD Plus (PPO) service area include the following counties in Maryland: Anne Arundel, Baltimore, Carroll, Frederick, Howard, Somerset, Washington, Wicomico, and Worcester. (Not available in Montgomery County.)
The Johns Hopkins Advantage MD Premier (PPO) service area includes Montgomery County only.
The Johns Hopkins Advantage MD (D-SNP) service area includes the following counties in Maryland: Anne Arundel, Howard and Montgomery. (Not available in Baltimore, Carroll, Frederick, Somerset, Washington, Wicomico and Worcester counties.)
The Johns Hopkins Advantage MD Tribute (HMO) and Johns Hopkins Advantage MD Primary (PPO) service area include the following counties in Maryland: Anne Arundel, Baltimore, Frederick, Howard, and Montgomery. (Not available in Carroll, Somerset, Washington, Wicomico, and Worcester counties.)
Going Out-of-NetworkCollapse
As a member of our PPO, Plus PPO, Primary PPO, or Premier 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, Tribute HMO, or D-SNP plans, 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.
Johns Hopkins OnDemand Virtual CareCollapse
Get care anytime, anywhere with Johns Hopkins OnDemand Virtual Care. Connect through your mobile device or computer for a video visit with a health care provider 24/7, from anywhere in the United States. Johns Hopkins OnDemand Virtual Care has providers ready to care for you at any time, no appointment needed. A health care provider is available within minutes to review symptoms and prescribe medications, as necessary.
Common uses for this service include minor care concerns, such as:
- Cold and flu symptoms
- Rashes
- Allergies
- Sinus problems
- Pinkeye
This service is available to all Advantage MD plan members.
Get connected with a provider now or learn more.
Do not use Johns Hopkins OnDemand Virtual Care for emergency medical matters.
Call 911 if you are experiencing a medical emergency.
Explanation of Hearing Aid CoverageCollapse
Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing.
Features for 2023
- Additional channels and programs for a more customized listening experience.
- State-of-the-art technology that helps you hear speech even in noisy environments.
- Own Voice Processing (OVP) for a more natural sound to your own voice.
- Smartphone-compatible directly to iPhone, iPad, and iPod Touch devices so you can stream audio and phone calls directly to your ears (connectivity is also available to many Android phones with use of a phone clip accessory.)
- Rechargeable battery upgrade option on the TruHearing Premium RIC Li, Slim RIC Li, Standard BTI Li, and CROS Li styles for an additional $50 per aid.
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
- 60-day trial
- 3-year manufacturer warranty for repairs and one-time loss and damage replacement
- 80 batteries per aid included with non-rechargeable models
How to Get Hearing Aids
- Call us and ask for TruHearing. PPO members: call 877-293-5325 (TTY: 711); HMO members: call 877-293-4998 (TTY: 711).
- A TruHearing hearing consultant will verify your coverage and help you set up a hearing exam with an audiologist or hearing instrument specialist in your area.
- If hearing loss is discovered, your audiologist or hearing instrument specialist will help you choose the right hearing aids and order them through TruHearing.
- When the hearing aids arrive, you’ll return to have them fitted and programmed by your audiologist or hearing instrument specialist.
*Three follow-up visits must be used within one year after the date of initial purchase. Forty-five-day trial and hearing aid returns, repairs, and replacements subject to provider and manufacturer fees. For questions regarding fees, contact TruHearing customer service at 800-334-1807 (TTY: 711).
The Silver&Fit® Exercise and Healthy Aging ProgramCollapse
With the Silver&Fit® Healthy Aging and Exercise program, you can choose either a fitness center membership at a participating fitness center or the Silver&Fit Home Fitness Program.
- You can join a participating Silver&Fit fitness center in our service area at no charge and take advantage of all of the services and amenities that are included as part of your basic fitness center membership.* Amenities offered by fitness centers vary by location. Any nonstandard fitness center service that typically requires an additional fee is not included in your basic fitness membership (for example, court fees or personal trainer services).
- You can switch to another participating Silver&Fit fitness center once a month and your change will be effective the first of the following month. To find a participating fitness center, you can search for the closest Silver&Fit fitness centers to you on the Silver&Fit website at www.SilverandFit.com.
- If you prefer to work out at home in lieu of a participating fitness center, you have the option to enroll in the Silver&Fit Home Fitness Program and receive up to two home fitness kits each benefit year at no charge.
- As an eligible member, you also have access to read the quarterly Silver Slate® newsletters and Healthy Aging educational materials by visiting the Silver&Fit website. Or you can request the Silver Slate newsletter and Healthy Aging Educational materials be mailed to you every quarter once you have enrolled into the Silver&Fit program.
*Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit and the Silver Slate are federally registered trademarks of ASH and used with permission herein.
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