2026 PPO

Plan Overview

$95 / month

Medical Deductible

This plan does not have any medical deductibles.

Pharmacy Deductible

$615 (Applies to drugs in Tiers 3, 4 and 5)

Coverage Details

Maryland counties: Anne Arundel, Baltimore, Carroll, Frederick, Howard, Montgomery, Somerset, Washington, Wicomico and Worcester.

Medical

Medical Deductible	This plan does not have any medical deductibles.
Primary Care Provider Visit	$5 copay Out-of-network: 40% coinsurance
Specialist Visit	$45 copay Out-of-network: 40% coinsurance
Referrals	Not required
Telehealth	$0 copay
Urgent Care	In-network & Out-of-network: $40 copay The copay is not waived if you are admitted to the hospital.
Emergency Care	In-network & Out-of-network: $115 copay. The copay is waived if you are admitted to the hospital within 24 hours for the same condition.
Worldwide Emergency & Urgently Needed Services	$115 copay for emergency care services and $40 copay for urgent care services. Inpatient care is not covered.
Inpatient Hospital Stay	$330/day copay for days 1-6; $0 copay for days 7-90
Outpatient Surgery	$250 copay Out-of-network: 50% coinsurance
Acupuncture	Medicare-covered Acupuncture: In-Network: $0 – $45 copay, based on location of service Out-of-Network: 40% coinsurance Non-Medicare covered Acupuncture: Not Covered
Chiropractic Services	Medicare-covered chiropractic care: In-network: $15 copay Out-of-network: 50% coinsurance
Podiatry Services	Medicare-covered podiatry care: In-network: $45 copay Out-of-Network: 50% coinsurance Non-Medicare covered podiatry care: Not covered
Hearing Services Learn more	Routine hearing exam: In-network: You pay nothing (one routine hearing exam per year from a TruHearing provider.) Out-of-network: 50% coinsurance Hearing aids: 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	$0 copay for participating fitness centers.
Prescription
Pharmacy Deductible	$615 (Applies to drugs in Tiers 3, 4 and 5)
Preferred Generic (Tier 1)	$0 for a one-month supply $0 for a two-month supply $0 for a three-month supply
Generic (Tier 2)	$15 for a one-month supply $22.50 for a two-month supply $30 for a three-month supply
Preferred Brand (Tier 3)	25% ($35 for Select Insulins) for a one-month supply 25% ($70 for Select Insulins) for a two-month supply 25% ($105 for Select Insulins) for a three-month supply
Non-Preferred Drug (Tier 4)	25% ($35 for Select Insulins) for a one-month supply 25% ($70 for Select Insulins) for a two-month supply 25% ($105 for Select Insulins) for a three-month supply
Specialty Tier (Tier 5)	25% of the total cost of a one-month supply (long-term supply is not available)
Mail Order	Available
Vision
Medicare-covered exam to diagnose and treat diseases and conditions of the eye	In-network: $50 copay Out-of-network: 50% coinsurance
Yearly Glaucoma Screening	In-network: $0 copay Out-of-network: 50% coinsurance
Routine Eye Exam	In-network: $0 copay Out-of-network: 50% coinsurance
Eyeglasses or Contact Lenses after Cataract Surgery	In-network: $0 copay Out-of-network: 50% coinsurance
Routine Eyewear	Our plan pays up to $200 every year for supplemental eyewear from any in-network Superior Vision provider.
Dental
Medicare-covered Dental Services	In-network: $0 copay Out-of-network: 50% coinsurance
Preventive Dental Services	(2 cleanings per year): In-network: $0 copay Out-of-network: 50% coinsurance Oral exam(s) (Frequency determined by type of oral exam): In-network: $0 copay Out-of-network: 50% coinsurance Dental X-Ray(s) (Frequency determined by type of X-Ray): In-network: $0 copay Out-of-network: 50% coinsurance
Fluoride Treatments	(2 fluoride treatments per year): In-network: $0 copay Out-of-network: 50% coinsurance
Comprehensive Dental Services	Not covered
Optional Supplemental Benefits	$23 monthly premium (Frequency dependent on procedure) The plan has a maximum coverage amount of $1,000 per year for in-and out-of-network non-Medicare-covered comprehensive dental services. Members are responsible for the difference between the allowed amount and the billed amount for any out-of-network services.
Restorative services (such as inlays, onlays, crowns, resin restoration, etc.)	Frequency dependent on procedure. In-network & Out-of-network: $50 copay
Endodontics	Frequency dependent on procedure. In-network & Out-of-network: $100 copay
Periodontics	Frequency dependent on procedure. In-network & Out-of-network: $50 copay
Extractions	Frequency dependent on procedure. In-network & Out-of-network: $100 copay
	Frequency dependent on procedure. In-network & Out-of-Network: $50-$100 copay depending on the service
Documents
2026 Summary of Benefits (PPO) 2026 Annual Notice of Changes (PPO) 2026 Evidence of Coverage (PPO) Pre-Enrollment Checklist – English \| Spanish 2026 PPO LIS Premium Summary Chart

2027 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $8,950. Johns Hopkins Advantage MD Tribute (HMO) has an in-network out-of-pocket maximum of $7,200. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,950 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. Johns Hopkins Advantage MD Access (PPO) has an in-network out-of-pocket maximum of $8,000 and a combined in- and out-of-network maximum of $11,300. Johns Hopkins Advantage MD BMORE Balanced (HMO-DSNP) and Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $9,850. Johns Hopkins Advantage MD Select (HMO) has an in-network out-of-pocket maximum of $9,250.

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. Johns Hopkins Advantage MD BMORE Balanced (HMO-DSNP) and Johns Hopkins Advantage MD Access (PPO) have a $1,000 allowance for comprehensive dental services added to your Flex Card. Johns Hopkins Advantage MD D-SNP (HMO) has $1,000 annual maximum for comprehensive dental services. Johns Hopkins Advantage MD Select (HMO) has $1,500 annual maximum for comprehensive dental services. Johns Hopkins Advantage MD Tribute (HMO) has $2,000 annual maximum for comprehensive dental services.

Prior authorizations may be required for some services, contact Member Services for more details.

2026 Plans

Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $8,950. Johns Hopkins Advantage MD Tribute (HMO) has an in-network out-of-pocket maximum of $6,800. Johns Hopkins Advantage MD (PPO), Johns Hopkins Advantage MD Plus (PPO), Johns Hopkins Advantage MD Primary (PPO) have 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 $9,250. Johns Hopkins Advantage MD Select (HMO) has an in-network out-of-pocket maximum of $9,250

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), Johns Hopkins Advantage MD (PPO), Johns Hopkins Advantage MD Plus (PPO), and Johns Hopkins Advantage MD Primary (PPO) plan has a $1,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Tribute (HMO) and Johns Hopkins Advantage MD D-SNP (HMO) has a $2,000 Annual Maximum. The comprehensive dental benefit for the Johns Hopkins Advantage MD Select (HMO) has a $2,400 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).

Text Size:

2026 PPO

Plan Overview

Coverage Details

Service Area

Request a call