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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 2025, 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 out of 5 stars in 2025.
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 $20.00. 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 $7550.00 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) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you may pay a $10 copay at a standard or mail-order pharmacy. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Johns Hopkins Advantage MD (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance services with a $240 copay. Primary care services have copays depending on the service, with no copay for chiropractic services. Preventive services include several screenings and programs, with coverage for hearing exams, vision services, and dental services with coinsurance and copays. Additional benefits include coverage for home infusion services, dialysis services, medical equipment with coinsurance, diagnostic and radiological services, and home health services with no copay. The plan also covers skilled nursing facility services with a copay after the initial 20 days and offers an over-the-counter benefit and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For the first 5 days of an inpatient stay, there is a $350 copay, and days 6-90 have no copay; there is no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a copay of $320, ASC Services have a $225 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20. Outpatient Blood Services include an enhanced benefit with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by Johns Hopkins Advantage MD (HMO), but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Johns Hopkins Advantage MD (HMO), with no coinsurance for ambulance services. Ground and Air Ambulance Services have a copay of $240.00. Transportation Services to any health-related location are not covered. Transportation Services - Plan Approved Health-related Location is covered with a limit of 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Johns Hopkins Advantage MD (HMO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance; Worldwide Emergency Services are not covered.
Primary Care See details
The Johns Hopkins Advantage MD (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, physician specialist services with a $45 copay, and mental health specialty services with a $20-$20 copay. The plan also covers podiatry services with a 20% coinsurance and a $50 copay for routine foot care, other health care professionals with a $0-$45 copay, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services.
Preventive Services See details
Preventive Services, including Medicare-covered services, an annual physical exam, and other preventive services are covered. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) are covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, both of which have no deductible. Routine hearing exams are limited to one visit per year. Prescription hearing aids are covered with a copay between $699 and $999, and are limited to two per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include eye exams with a copay of $0-$50. Eyewear is covered with a combined maximum benefit of $250 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The Johns Hopkins Advantage MD (HMO) plan covers Medicare Dental Services with 20% coinsurance. Oral exams, dental x-rays, and prophylaxis (cleaning) have a $20 copay, but fluoride treatments, orthodontic services, and other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Johns Hopkins Advantage MD (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance. Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with at most 20% coinsurance, and outpatient X-ray services with a $20 copay. Lab services are not covered, while diagnostic radiological services have a copay of at most $175.00, and therapeutic radiological services have at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Johns Hopkins Advantage MD (HMO), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Johns Hopkins Advantage MD (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20, and the copay is $203 per day for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and a Meal Benefit, but Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The OTC benefit provides a maximum of $60 every three months.
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