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Johns Hopkins Advantage MD (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Johns Hopkins Advantage MD (HMO) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD (HMO) is a HMO plan offered by Johns Hopkins Healthcare LLC available for enrollment in 2025 to people living in Counties: AA BL CR FR HW MG SS WH WC WR. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Johns Hopkins Advantage MD (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Johns Hopkins Advantage MD (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Johns Hopkins Advantage MD (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8950.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Johns Hopkins Advantage MD (HMO) prescription drug plan features an annual drug deductible of $590. For Tier 1 preferred generic drugs, members pay no copay for a one-month, two-month, or three-month supply filled through standard pharmacies or standard mail-order services. Tier 2 generic drugs are also highly affordable, requiring a standard copay of $6 for a one-month supply, $9 for a two-month supply, or $12 for a three-month supply. For Tier 3 preferred brand drugs, standard coverage costs $45 for a one-month supply, though standard mail order offers a discounted $67.50 copay for a two-month supply. Higher-tier medications are covered via coinsurance, with Tier 4 non-preferred drugs requiring a 25% coinsurance and Tier 5 specialty drugs requiring a 26% coinsurance for a one-month supply.
Additional Benefits
The Johns Hopkins Advantage MD (HMO) plan provides comprehensive medical coverage with no copay for primary care visits, telehealth, and annual preventive services. Specialist visits require a $45 copay, while inpatient hospital stays carry a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Outpatient hospital services require a $320 copay, and emergency room visits feature a $115 copay that is waived upon hospital admission. Additional benefits include routine dental cleanings, annual hearing exams, and home health services with no copay or coinsurance. Vision care is covered with an eye exam copay up to $50 and a $250 annual allowance for eyewear, alongside up to 24 one-way transportation trips to approved locations with no copay. Members also receive an over-the-counter benefit of up to $30 every three months and a chronic illness meal benefit with no copay.
Inpatient Hospital See details
Johns Hopkins Advantage MD (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Johns Hopkins Advantage MD (HMO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $320 copay and ambulatory surgical center services for a $225 copay. Outpatient substance abuse services are covered with a $20 copay per session and no coinsurance, while outpatient blood services require no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Johns Hopkins Advantage MD (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Johns Hopkins Advantage MD (HMO) covers ground and air ambulance services with a $240 copay and no coinsurance. The plan also provides up to 24 one-way transportation trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to non-approved health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Johns Hopkins Advantage MD (HMO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services require a $40 copay and no coinsurance. Worldwide emergency services are not covered in practice, as worldwide emergency coverage, urgent coverage, and emergency transportation are all excluded.
Primary Care See details
Johns Hopkins Advantage MD (HMO) offers primary care physician services, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $30 copay and no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Johns Hopkins Advantage MD (HMO) covers preventive services, including annual physical exams, kidney disease education, and specific screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering memory fitness and remote access technologies with no copay and no coinsurance, while services such as health education, weight management, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by Johns Hopkins Advantage MD (HMO), offering one annual routine exam and unlimited fittings with no copay or coinsurance. Up to two prescription hearing aids per year are covered with a copay of $699 to $999 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Johns Hopkins Advantage MD (HMO) covers one routine eye exam per year with a $0 to $50 copay, no coinsurance, and no deductible, while other eye exams are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual maximum, though upgrades are excluded.
Dental Services See details
Dental services are partially covered by Johns Hopkins Advantage MD (HMO), which offers no copay and no coinsurance for Medicare-covered dental care, oral exams, x-rays, cleanings, and fluoride treatments. Other diagnostic and preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD (HMO) covers Home Infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Johns Hopkins Advantage MD (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Johns Hopkins Advantage MD (HMO) partially covers medical equipment, providing durable medical equipment, prosthetics, and diabetic therapeutic shoes with no copay and 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Johns Hopkins Advantage MD (HMO) because lab services are not covered, and prior authorization is required. Covered diagnostic tests carry a 20% coinsurance and no copay, while diagnostic radiology requires a $175.00 copay (no coinsurance), therapeutic radiology requires a 20% coinsurance (no copay), and outpatient X-rays require a $20.00 copay (no coinsurance).
Home Health Services See details
Home health services are covered by Johns Hopkins Advantage MD (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Johns Hopkins Advantage MD (HMO) plan, as all related sub-services, including intensive cardiac, pulmonary, and SET for PAD services, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Johns Hopkins Advantage MD (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Johns Hopkins Advantage MD (HMO) covers select other services, including a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $30 every three months for select items, while acupuncture and other additional services are not covered.
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