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888-403-7682 (TTY: 711)†
8 a.m. to 8 p.m., Monday-Sunday
2027 D-SNP (HMO D-SNP)
Accepting enrollments
Accepting enrollments
This plan is currently accepting enrollments.
Coverage Details
Maryland counties: Anne Arundel, Baltimore, Carroll, Frederick, Howard, Montgomery, Somerset, Washington, Wicomico and Worcester.
To qualify for this plan you must be eligible for both Medicare and Medicaid.
Eligible members can receive a Benefits Mastercard Prepaid Card* to help pay for monthly healthy food expenses.
| Medical | |
|---|---|
| Medical Deductible | This plan does not have any medical deductibles. |
| Primary Care Provider Visit | $0 copay |
| Specialist Visit | $0 copay |
| Referrals | Not required. |
| Telehealth | $0 copay |
| Urgent Care | $0 copay |
| Emergency Care | $0 copay |
| Worldwide Emergency & Urgently Needed Services | Not covered |
| Inpatient Hospital Stay | $0 copay up to 90 days |
| Outpatient Surgery | $0 copay at an Ambulatory Surgical Center |
| Acupuncture | Medicare-covered Acupuncture: $0 copay Non-Medicare covered Acupuncture: Not covered |
| Chiropractic Services | Medicare-covered Chiropractic Services: $0 copay |
| Podiatry Services | Medicare-covered Podiatry Services: $0 copay |
| Hearing Services | $0 copay for diagnostic hearing exams |
| OTC Allowance | $50 per quarter |
| Flex Card | Advantage MD’s Flex Card is a prepaid card to help eligible members pay for monthly healthy food and produce.* Members receive a Benefits Mastercard Prepaid Card. Advantage MD loads the card every month with $75. |
| Transportation | 36 one-way trips |
| Silver&Fit® Program | $0 copay for participating fitness centers. |
| Prescription | |
| Pharmacy Deductible | If you qualify for Low Income Subsidy (LIS), you pay: $0 If you don’t qualify for Low Income Subsidy (LIS), you pay: $700 |
| Cost-Sharing for Covered Drugs | If you qualify for Low Income Subsidy (LIS)*, you pay: LIS Level 1: $5.80 for generics (including brand drugs treated as generics) and $14.40 for all other drugs up to a 100-day supply LIS Level 2: $1.65 for generics (including brand drugs treated as generics) and $5.00 for all other drugs up to a 100-day supply LIS Level 3: $0 for up to a 100-day supply If you don’t qualify for Low Income Subsidy (LIS), you pay: 25% co-insurance for up to a 100-day supply *Cost sharing is based on your level of Extra Help. |
| Mail Order | Available — Get eligible prescription medications delivered directly to your home. Mail order may be available for up to a three-month supply of many maintenance medications. Contact Member Services to learn how to get started. |
| Vision | |
| Medicare-covered exam to diagnose and treat diseases and conditions of the eye | $0 copay |
| Yearly Glaucoma Screening | $0 copay |
| Routine Eye Exam | $0 copay |
| Eyeglasses or Contact Lenses after Cataract Surgery | $0 copay |
| 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 | $0 copay |
| Preventive Dental Services | Cleaning(s) (2 cleaning per year): $0 copay |
| Fluoride Treatments | (2 fluoride treatments per year): $0 copay |
| Comprehensive Dental Services | The plan has a maximum coverage amount of $1,000 per year for in-network non-Medicare-covered comprehensive dental services. Frequency is dependent on procedure. |
| Restorative services (such as inlays, onlays, crowns, resin restoration, etc.) | $0 copay |
| Endodontics | $0 copay |
| Periodontics | $0 copay |
| Extractions | $0 copay |
| Prosthodontics (fixed & removable), Implants, and Oral & Maxillofacial Surgery | $0 copay |
| Optional Supplemental Benefits | Not Available |
| Documents | |
| |
*The benefits mentioned are a part of special supplemental program for the chronically ill and include the following conditions: autoimmune disorders, cardiovascular disorders, chronic heart failure, diabetes, chronic lung disorders. Other conditions apply but are not listed in this disclaimer. Not all members qualify. Coverage of the item or service depends on the chronically ill classification as defined in 42 CFR §422.102(f)(1)(i)(A) and on Johns Hopkins Advantage MD’s SSBCI coverage criteria required by 42 CFR §422.102(f)(4).
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).