Understand Your Benefits
With so many benefits, it’s important to understand your Advantage MD coverage. This will help you 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 the Benefits Explorer, an interactive tool that makes it easy to browse your covered benefits. You can also download a PDF of the Summary of Benefits.
Switch between Medicare Plans and Supplemental Dental Plan
Medicare Plans
Supplemental Dental Plan| 2017 Advantage MD PPO Plans* | |||
|---|---|---|---|
| Plans & Monthly Plan Premium | |||
| Plans & Monthly Plan Premium |
Johns Hopkins
|
Johns Hopkins
|
ORIGINAL MEDICARE
|
| MEDICAL BENEFITS (Partial listing: In-network) | |||
| MEDICAL BENEFITS (Partial listing: In-network) | |||
| Medical Deductible | |||
| Medical Deductible | $0 | $0 | Part A $1,316 & Part B $183 |
| Primary Care Provider Visit | |||
| Primary Care Provider Visit | $10 copay | $5 copay | 20% of the cost |
| Specialist Visit | |||
| Specialist Visit | $50 copay | $40 copay | 20% of the cost |
| Referrals | |||
| Referrals | Not required | Not required | Not required |
| Urgent Care | |||
| Urgent Care | $50 copay | $40 copay | 20% of the cost |
| Outpatient Surgery, ASC | |||
| Outpatient Surgery, ASC | $275 copay | $200 copay | 20% of the cost |
| Emergency Care | |||
| Emergency Care | $75 copay | $75 copay | 20% of the cost |
| Inpatient Hospital Stay | |||
| Inpatient Hospital Stay | $275/day copay for days 1-7; $0 copay for days 8-90 | $250/day copay for days 1-7; $0 copay for days 8 and beyond | $1,316 deductible for days 1-60; $329/day copay for days 61-90; $658/day copay for 60 lifetime reserve days |
| Annual Routine Vision Exam | |||
| Annual Routine Vision Exam | $10 copay | $0 copay; up to $150 every other year for eyewear | 20% of the cost |
| Empty Header | |||
|---|---|---|---|
| Diagnostic Dental Services | |||
| Diagnostic Dental Services | $30-$55 copay, depending on service | $20-$40 copay, depending on service | Limited coverage |
| Supplemental Dental | |||
| Supplemental Dental | Optional | Optional | 20% of the cost |
| Chiropractic Care | |||
| Chiropractic Care | $20 copay | $20 copay | 20% of the cost |
| Hearing Aid Services Learn More | |||
| Hearing Aid Services Learn More |
N/A | Two options available; copay from $699 per aid | 20% of the cost |
| Silver&Fit® Program Learn More | |||
| Silver&Fit® Program Learn More |
N/A | Included | Not covered |
| PRESCRIPTION DRUG BENEFITS (30-day supply; preferred network pharmacy) | |||
| PRESCRIPTION DRUG BENEFITS (30-day supply; preferred network pharmacy) | |||
| Deductible | |||
| Deductible | $0 | $0 | Not covered |
| Preferred Generic | |||
| Preferred Generic | $7 copay | $4 copay | Not covered |
| Generic | |||
| Generic | $15 copay | $12 copay | Not covered |
| Preferred Brand | |||
| Preferred Brand | $45 copay | $42 copay | Not covered |
| Non-Preferred Drug | |||
| Non-Preferred Drug | $95 copay | $92 copay | Not covered |
| Specialty Tier | |||
| Specialty Tier | 33% of the cost | 33% of the cost | Not covered |
| Mail Order Available | |||
| Mail Order Available | When ordering 90-day supply | When ordering 90-day supply | Not covered |
*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 2017. 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 for 2017. 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, premium and/or copayments/coinsurance may change on January 1 of each year.
You must continue to pay your Part B premium.
| 2017 Advantage MD Dental PPO* | |
|---|---|
| Plans & Monthly Plan Premium | |
| Plans & Monthly Plan Premium |
Johns Hopkins
|
| BASIC RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| BASIC RESTORATIVE (In-network) *Out-of-network cost may be higher | |
| Endodontics | |
| Endodontics | $200 copay |
| Oral Surgery | |
| Oral Surgery | $50 copay |
| Oral Pathology Biopsy | |
| Oral Pathology Biopsy | $50 copay |
| Periodontics | |
| Periodontics | $50 copay |
| Restorative Fillings | |
| Restorative Fillings | $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 copay |
| 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) |
$400 copay |
| 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 copay |
| Empty Header | |
|---|---|
| Bridges Replacement (due to structural changes in the mouth) |
|
| Bridges Replacement (due to structural changes in the mouth) |
$400 copay |
| Crowns, Inlays and Onlays Installation | |
| Crowns, Inlays and Onlays Installation | $400 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) |
$50 copay |
| Crowns, Inlays and Onlays Replacement | |
| Crowns, Inlays and Onlays Replacement | $400 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) |
$400 copay |
| 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) |
$50 copay |
| 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) |
$400 copay |
*Please note: this information does not apply to Advantage MD Group.
Limitations: 1. After enrolling in the supplemental dental plan, there is a six-month waiting period before these services will be covered. 2. Members are responsible for the difference between the allowed amount and the billed amount. For more information, please review the Evidence of Coverage. 3. $1,200 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 Area
Advantage MD offers two plans for Medicare-eligible residents in 11 counties in Maryland. Residents of these counties can sign up for Advantage MD or Advantage MD Plus. See the map below for our service area.
Going Out-of-Network
As a member of our plan, you can choose to receive care from out-of-network providers. Our plan will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary. However, if you use an out-of-network provider, your share of the costs for your covered services may be higher. For more specific information, view Chapter 3 of your Evidence of Coverage (EOC).
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