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2027 Select (HMO)
Accepting enrollments
Accepting enrollments
This plan is currently accepting enrollments.
Coverage Details
Virginia counties: Alexandria City, Arlington, Fairfax City, Fairfax, Falls Church City, Loudoun, Manassas City, and Prince William.
| Medical | |
|---|---|
| Medical Deductible | This plan does not have any medical deductibles. |
| Primary Care Provider Visit | $0 copay |
| Specialist Visit | $30 copay |
| Referrals | Not required. |
| Telehealth | $0 copay |
| Urgent Care | $40 copay |
| Emergency Care | $115 copay |
| Worldwide Emergency & Urgently Needed Services | $115 for emergency care services and $40 copay for urgent care services. Emergency and urgent care services are covered up to a maximum of $50,000 each year. |
| Inpatient Hospital Stay | $400/day copay for days 1-5; $0 copay for days 6-90 |
| Outpatient Surgery | $250 copay at an Ambulatory Surgical Center |
| Acupuncture | Medicare-covered Acupuncture: $0 – $30 copay, based on location of service Non-Medicare covered Acupuncture: $0 copay (up to 24 combined visits per year for non-Medicare covered acupuncture, Routine Foot Care, and Non-Medicare covered chiropractic) |
| Chiropractic Services | Medicare-covered Chiropractic Services: Non-Medicare covered Chiropractic Services: |
| Podiatry Services | Medicare-covered Podiatry Services: $30 copay Routine Foot Care: $0 copay (up to 24 combined visits per year for Routine Foot Care, Non-Medicare covered chiropractic, and non-Medicare covered acupuncture) |
| Hearing Services | $0 copay for diagnostic hearing exams |
| OTC Allowance | $25 per quarter |
| Silver&Fit® Program | $0 copay for participating fitness centers. |
| Prescription | |
| Pharmacy Deductible | $250 |
| Preferred Generic (Tier 1) | $0 copay for a 30-day supply |
| Generic (Tier 2) | $5 copay for a 30-day supply |
| Preferred Brand (Tier 3) | $45 copay ($35 for Select Insulins) for a 30-day supply |
| Non-Preferred Drug (Tier 4) | 30% co-insurance ($35 for Select Insulins) for a 30-day supply |
| Specialty Tier (Tier 5) | 30% co-insurance for a 30-day supply (only) |
| 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 | $50 copay |
| Yearly Glaucoma Screening | $0 copay |
| Routine Eye Exam | (1 every year) |
| 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 cleanings per year): $0 copay Oral exam(s) (Frequency determined by type of oral exam): $0 copay Dental X-Ray(s) (Frequency determined by type of X-Ray): $0 copay |
| Fluoride Treatments | Fluoride treatments (2 fluoride treatments per year): $0 copay |
| Comprehensive Dental Services | The plan has a maximum coverage amount of $1,500 per year for in-network non-Medicare-covered comprehensive dental services. Frequency is dependent on procedure. |
| Optional Supplemental Benefits | Not Available |
| 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 |
| Documents | |
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).