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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 2025, 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 2025.
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 $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 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 has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs in the standard pharmacy, you will pay a $15 copay for preferred generics, and 25% coinsurance for standard generics. For brand name and non-preferred drugs, you will pay 25% coinsurance in the standard pharmacy. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Johns Hopkins Advantage MD (PPO) plan offers a wide range of benefits with varying cost-sharing structures. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $40 to $330 depending on the specific service. You'll also find coverage for emergency and urgent care services, as well as primary care and specialist visits with copays of $5 and $45, respectively. Additional benefits include coverage for preventive, hearing, vision, and dental services, with copays and coinsurance amounts varying by service. The plan also covers home health services, skilled nursing facility stays, and medical equipment. However, certain services like acupuncture, over-the-counter items, and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-6 and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services and observation services have a $320 copay, while ambulatory surgical center services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $40, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Johns Hopkins Advantage MD (PPO) plan. This benefit has a $50 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Johns Hopkins Advantage MD (PPO), including both ground and air ambulance services, each with a $210 copay and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Johns Hopkins Advantage MD (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Johns Hopkins Advantage MD (PPO) plan covers primary care physician services for a $5 copay and specialist services for a $45 copay. Chiropractic services are covered with a $15 copay, while occupational therapy services have a $35 copay, and require prior authorization. Mental health specialty services, psychiatric services, and podiatry services are covered with varying copays and coinsurance amounts, and routine foot care has a $50 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, and additional preventive services. Kidney disease education services have a copay of $15. Some additional services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, and prescription hearing aids with a copay between $699 and $999 for all types, except for inner ear, outer ear, and over the ear hearing aids which are not covered. Routine hearing exams and fitting/evaluation for hearing aids are covered.
Vision Services See details
Vision services include routine eye exams with a copay of $0-$50, and eyewear benefits, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. The plan offers a combined maximum benefit of $300 per year for all eyewear. Upgrades are not covered.
Dental Services See details
Johns Hopkins Advantage MD (PPO) covers a variety of dental services including oral exams, dental x-rays, cleanings, and fluoride treatments. Orthodontic services are covered with a maximum benefit of $1000 per year, and other services like restorative services, endodontics, and periodontics require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Johns Hopkins Advantage MD (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Johns Hopkins Advantage MD (PPO) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Prosthetic/Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are covered, with some subject to 20% coinsurance and no copay, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have no coinsurance. Diagnostic Radiological Services have a copay of at most $250, and outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Johns Hopkins Advantage MD (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but some services are not covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is coinsurance for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Johns Hopkins Advantage MD (PPO) with prior authorization required. There is no copay for days 1-20, and a $160 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Johns Hopkins Advantage MD (PPO) plan, including acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and more. Referrals and authorizations are not required for these services.
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