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Johns Hopkins Advantage MD D-SNP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD D-SNP (HMO D-SNP). 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 D-SNP (HMO D-SNP) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) is a HMO D-SNP plan offered by Johns Hopkins Healthcare LLC available for enrollment in 2025 to people living in AA BL CR HW FR 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 D-SNP (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Johns Hopkins Advantage MD D-SNP (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Johns Hopkins Advantage MD D-SNP (HMO D-SNP).
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 D-SNP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.20. 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 $615.00 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 $9250.00 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 D-SNP (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Detailed information regarding specific drug tier copayments, coinsurance rates, and coverage levels is currently not available for this plan. To determine your exact prescription costs, it is best to review the plan's formulary or contact the provider directly to see how your specific medications are classified.
Additional Benefits
The Johns Hopkins Advantage MD D-SNP (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, home health, and skilled nursing facility care. For outpatient services, primary care, emergency visits, and durable medical equipment, members generally pay no copay and a 20% coinsurance. Additionally, the plan includes essential transportation benefits, covering up to 36 one-way trips per year to approved locations with no copay and no coinsurance. This plan also features strong supplemental benefits, providing routine dental, vision, and hearing care with no copay and no coinsurance. Members receive a $2,000 annual dental limit, up to $200 yearly for eyewear, and up to $1,500 every two years for prescription hearing aids. Furthermore, the plan includes a $50 quarterly allowance for over-the-counter items and a meal benefit for chronic illness with no copay and no coinsurance.
Inpatient Hospital See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. The benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for some hospital and surgical services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Johns Hopkins Advantage MD D-SNP (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation benefits are partially covered, providing up to 36 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers emergency services and urgently needed services with a 20% coinsurance (up to $115 and $40 per visit, respectively) and no copay, which do not count toward the plan deductible and are waived if admitted to the hospital within three days. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and 20% coinsurance. Telehealth services are available with no copay and no coinsurance, while routine chiropractic and podiatry services are partially covered for up to 12 visits per year with no copay and 20% coinsurance.
Preventive Services See details
Preventive services are covered by Johns Hopkins Advantage MD D-SNP (HMO D-SNP), offering annual physical exams and zero-dollar preventive services with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance for memory fitness and remote access, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling. Kidney disease education and other select screenings, including glaucoma, diabetes self-management, digital rectal exams, and EKGs, are covered with no copay and 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Johns Hopkins Advantage MD D-SNP (HMO D-SNP) with no copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are covered up to $1,500 every two years with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) provides partially covered vision services with no deductible, no copay, and no coinsurance, including one routine eye exam per year and up to $200 annually for contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, up to a $2,000 annual limit. Covered services include oral exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery, while other diagnostic and preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs—including chemotherapy, insulin, and other infusion drugs—carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these services, and preferred vendor limitations may apply to durable medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Johns Hopkins Advantage MD D-SNP (HMO D-SNP), requiring prior authorization and featuring no copay alongside a 20% coinsurance for covered services. While outpatient diagnostic procedures, X-rays, and diagnostic or therapeutic radiological services are covered, lab services are not covered.
Home Health Services See details
Home Health Services are covered by Johns Hopkins Advantage MD D-SNP (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, but key sub-services are not covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and are subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan permits admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Johns Hopkins Advantage MD D-SNP (HMO D-SNP) are partially covered, featuring a meal benefit for chronic illness and over-the-counter (OTC) items with no copay and no coinsurance. While OTC items are covered up to $50 every three months, acupuncture is not covered under this plan.
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