Plan Benefits Overview

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.

2017 Advantage MD PPO Plans*
MEDICAL BENEFITS
(Partial listing: In-network)
Johns Hopkins
ADVANTAGE MD (PPO)
Johns Hopkins
ADVANTAGE MD PLUS (PPO)
Medical Deductible $0 $0
Primary Care Provider Visit $10 copay $5 copay
Specialist Visit $50 copay $40 copay
Referrals Not required Not required
Urgent Care $50 copay $40 copay
Outpatient Surgery, ASC $275 copay $200 copay
Emergency Care $75 copay $75 copay
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
Annual Routine Vision Exam $10 copay $0 copay; up to $150 a year for eyewear
Diagnostic Dental Services $30-$55 copay,
depending on service
$20-$40 copay,
depending on service
Supplemental Dental Optional Optional
Chiropractic Care $20 copay $20 copay
Hearing Aid Services
(Learn More)
N/A Two options available, copay from $699 per aid
Silver&Fit® Program
(Learn More)
N/A Included
Monthly Plan Premium $44 $78
PRESCRIPTION DRUG BENEFITS (30-day supply; preferred network pharmacy)
Deductible $0 $0
Preferred Generic $7 copay $4 copay
Generic $15 copay $12 copay
Preferred Brand $45 copay $42 copay
Non-Preferred Drug $95 copay $92 copay
Specialty Tier 33% of the cost 33% of the cost
Mail Order Available When ordering 90-day supply When ordering 90-day supply
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.
*Please note: this information does not apply to Advantage MD Group.

Medicare Part B vs. Part D

Your Johns Hopkins Advantage MD plan covers many of the medications you need to make the most of your health. How those medications are covered depends on the type of medications you receive and where you receive them. See examples of Part B and Part D medications and where to obtain them.

 

Part B – Medical Coverage

This part of Medicare pays for things like doctor visits, lab tests, home health care, and certain medical supplies and medications.

 

Part D – Pharmacy Coverage

This part of Medicare pays for the medications that you take regularly or for a short time.

 

Understanding the Difference

Most of your prescriptions and medications are covered by Part D. You can get these from your pharmacy. However, some medications and other items (such as diabetes testing supplies) are covered by Part B, and may be available at your pharmacy or through an Advantage MD durable medical equipment (DME) vendor.

Certain medications could be covered by either Part B or Part D depending on the use of the medication and your diagnosis.  Your provider may have to submit a coverage determination request to figure out if a drug is covered under Part B or Part D before getting it from the pharmacy.

View prescription drug coverage for 2017.

 

Diabetes Testing Supplies

Diabetes testing supplies are covered under Medicare Part B. Supplies like meters, lancets, and test strips can be purchased at a network pharmacy, but nebulizers and other equipment must be purchased through a DME vendor. If you have any questions, call Customer Service at 1-877-293-5325, option 3 (TTY: 711).

If you previously purchased diabetes testing supplies from a pharmacy without using your Advantage MD insurance, you may fill out a Part B claim form to go through the reimbursement process.

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.

Explanation of Hearing Aid Coverage for Advantage MD Plus Members

Johns Hopkins Advantage MD Plus covers up to two Flyte hearing aids per year when purchased through TruHearing. Flyte hearing aids are compatible with iPhone®, iPad®, and iPod® touch, and are available in a variety of styles in both advanced and premium features.

 

Copays

  • Flyte™ 700: $699 per aid
  • Flyte™ 900: $999  per aid
  • Initial hearing exam: $40

Included with hearing aids

  • 3 follow-up visits with an in-network provider for fitting and adjustment of hearing aids
  • 45-day trial period
  • 3-year manufacturer warranty for repairs and one-time loss and damage replacement
  • 48 batteries per aid

 

For more details about coverage, read the TruHearing flier.

To get started, call TruHearing to schedule a hearing exam today: 1-844-341-9735 (TTY: 1-800-975-2674)

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.

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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).