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Johns Hopkins Advantage MD (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD (PPO). 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 (PPO) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD (PPO) is a PPO 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 2026.
It's important to know that Johns Hopkins Advantage MD (PPO) 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 (PPO).
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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $95.00. 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 $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 combined Maximum Out-Of-Pocket cost of $11300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $11300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are available with standard copays of $15 for a one-month supply, $22.50 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, cost-sharing transitions to a percentage-based coinsurance. Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance for standard retail and mail-order fills. This 25% coinsurance applies to one-, two-, and three-month supplies for Tiers 3 and 4, and to one-month supplies for Tier 5 specialty drugs.
Additional Benefits
The Johns Hopkins Advantage MD (PPO) plan offers affordable access to essential medical care, featuring a low $5 copay for primary care visits and no copay for telehealth services. Specialist visits require a $45 copay, while inpatient hospital stays are covered with a $330 daily copay for days one through six and no copay for days seven through 90. Outpatient hospital services require a $320 copay, and emergency room visits carry a $115 copay, which is waived if you are admitted. Routine preventive care, home health services, and preventive dental cleanings are covered with no copay and no coinsurance. Vision benefits include annual routine exams with no copay to a $50 copay and up to $200 for eyewear with no copay, while hearing aids are covered with copays ranging from $699 to $999. Durable medical equipment and dialysis services require a 20% coinsurance with no copay, though comprehensive dental care and diabetic supplies are not covered.
Inpatient Hospital See details
Johns Hopkins Advantage MD (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $330 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and the plan does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Johns Hopkins Advantage MD (PPO) covers outpatient services with no coinsurance, featuring a $320 copay for outpatient hospital and observation services and a $250 copay for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Johns Hopkins Advantage MD (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Johns Hopkins Advantage MD (PPO) covers ground and air ambulance services with a $210 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, trips to plan-approved locations and any health-related locations are not covered.
Emergency Services See details
Johns Hopkins Advantage MD (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered with no coinsurance up to a $50,000 maximum benefit, although worldwide emergency transportation is not covered.
Primary Care See details
Johns Hopkins Advantage MD (PPO) covers primary care visits with a $5 copay and specialist visits with a $45 copay, both with no coinsurance. Telehealth and opioid treatment services are offered with no copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Johns Hopkins Advantage MD (PPO) covers preventive services, including annual physical exams and select screenings, with no copay and no coinsurance. While kidney disease education requires a $15 copay and no coinsurance, other additional preventive benefits are only partially covered, offering memory fitness and remote access technologies with no copay or coinsurance, while excluding services like health education, weight management, and in-home support.
Hearing Services See details
Johns Hopkins Advantage MD (PPO) partially covers hearing services, offering annual routine hearing exams for a $50 copay and no coinsurance, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Johns Hopkins Advantage MD (PPO) with no deductibles and no coinsurance for all covered services. Routine eye exams are covered once per year with a $0 to $50 copay, and eyewear is covered with no copay up to a $200 annual limit, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under Johns Hopkins Advantage MD (PPO), offering Medicare-covered dental, oral exams, cleanings, fluoride, and X-rays with no copay and no coinsurance. Comprehensive and specialized treatments—including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, maxillofacial prosthetics, adjunctive general, and other diagnostic or preventive services—are not covered.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin additionally requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Johns Hopkins Advantage MD (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Johns Hopkins Advantage MD (PPO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Johns Hopkins Advantage MD (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with a 20% coinsurance and no copay. Radiological services range from a $30 copay plus coinsurance for X-rays to a $250 copay with no coinsurance for diagnostic radiology, while therapeutic radiology requires a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by Johns Hopkins Advantage MD (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Johns Hopkins Advantage MD (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, while a 30% coinsurance applies to Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Johns Hopkins Advantage MD (PPO) with no coinsurance and do not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Johns Hopkins Advantage MD (PPO) notes that some services are covered under the other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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