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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 2025, 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 out of 5 stars in 2025.
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 $46.30. 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 $8850.00 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) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs in each tier. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $46.30. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan offers a variety of health benefits, including coverage for inpatient and outpatient services, with coinsurance applying to many services. The plan includes coverage for primary care, preventive services, hearing and vision services, and dental services with varying cost-sharing structures. Additionally, the plan offers coverage for ambulance, transportation, and emergency services, with some services having a coinsurance. This plan also covers home health services with no copay, and home infusion services, as well as dialysis and medical equipment. The plan provides coverage for diagnostic and radiological services and Skilled Nursing Facility (SNF) benefits, but excludes certain services such as Cardiac Rehabilitation Services. Other services include over-the-counter items and meal benefits for chronic illnesses.
Inpatient Hospital See details
Inpatient hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered. Prior authorization is required, and coinsurance applies for covered services.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Urgently Needed Services, there is no copay, but there is a 20% coinsurance; however, Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Chiropractic Services, and Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance, while the other services have varying coinsurance.
Preventive Services See details
Preventive services are covered, including annual physical exams, with no copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with 20% coinsurance. However, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered. Fitness benefits and remote access technologies are covered.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered by this plan. Prescription hearing aids are covered, with a maximum benefit of $1500 every two years for both ears combined, and prescription hearing aids of all types are covered up to 2 visits every year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $400 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; upgrades are not covered.
Dental Services See details
The Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan covers a range of dental services, including oral exams, dental x-rays, cleaning, and fluoride treatments with a limited number of visits per year. Orthodontic services are covered up to a maximum of $2,500 per year, while the plan does not cover orthodontics. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered but require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. The coinsurance for both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has a 20% coinsurance, while Prosthetic Devices and Diabetic Supplies/Therapeutic Shoes/Inserts have a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under this plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered under the Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan 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 D-SNP (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance information is available in the plan details.
Other Services See details
The Johns Hopkins Advantage MD D-SNP (HMO D-SNP) plan does not cover 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. The plan covers Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and Meal Benefits for a chronic illness.
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