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Johns Hopkins Advantage MD Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD Plus (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 Plus (PPO) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD Plus (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 Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $155.00. 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 prescription drug coverage for the Johns Hopkins Advantage MD Plus (PPO) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month supplies through standard pharmacies and standard mail-order services. Tier 2 generic drugs require a copay 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, including Tier 3 preferred brand drugs and Tier 4 non-preferred drugs, members pay a 25% coinsurance for all supply durations. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply through standard retail pharmacies and standard mail order.
Additional Benefits
The Johns Hopkins Advantage MD Plus (PPO) plan offers robust coverage for core medical needs, featuring low predictable copays and many services with no coinsurance. Members enjoy no copay and no coinsurance for primary care visits, home health services, and routine preventive care, while specialist visits require a $40 copay. For hospital care, inpatient stays incur a $330 daily copay for the first six days, and outpatient hospital services carry a $320 copay. Additional benefits include routine dental cleanings and exams with no copay, alongside a $250 annual allowance for eyewear with no copay or coinsurance. Prescription hearing aids are covered with copays ranging from $699 to $999, while durable medical equipment and dialysis services require a 20% coinsurance and no copay. Emergency room visits are covered with a $110 copay, which is waived if you are admitted within 24 hours.
Inpatient Hospital See details
Johns Hopkins Advantage MD Plus (PPO) partially 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 additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Johns Hopkins Advantage MD Plus (PPO) covers outpatient hospital and observation services with a $320 copay and no coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Johns Hopkins Advantage MD Plus (PPO) for a $50 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Johns Hopkins Advantage MD Plus (PPO), with ground and air ambulance services requiring a $210 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Johns Hopkins Advantage MD Plus (PPO) covers emergency services with a $110 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with no coinsurance, featuring a $110 and $40 copay respectively, while worldwide emergency transportation is not covered.
Primary Care See details
Johns Hopkins Advantage MD Plus (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies carry a $30 copay with no coinsurance, and chiropractic care is partially covered with copays up to $20 and no coinsurance. Podiatry services are also available, requiring either a $40 copay for routine care or a 20% coinsurance for Medicare-covered services.
Preventive Services See details
Johns Hopkins Advantage MD Plus (PPO) offers preventive services with no copay and no coinsurance for annual physical exams, memory fitness, and routine screenings, while kidney disease education requires a $10 copay and no coinsurance. This benefit is partially covered because it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Johns Hopkins Advantage MD Plus (PPO) covers annual routine hearing exams with a $40 copay and no coinsurance, as well as unlimited hearing aid fitting evaluations. Prescription hearing aids are partially covered for up to two devices per year with a copay between $699 and $999 and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Johns Hopkins Advantage MD Plus (PPO) vision services are partially covered, excluding upgrades and other non-routine eye exam services. One routine eye exam per year is covered with a $0 to $40 copay and no coinsurance, and eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual maximum.
Dental Services See details
Johns Hopkins Advantage MD Plus (PPO) partially covers dental services with no copay and no coinsurance for Medicare-covered dental, oral exams, x-rays, cleanings, and fluoride treatments. However, other diagnostic and preventive services, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD Plus (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require up to 20% coinsurance, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Johns Hopkins Advantage MD Plus (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Johns Hopkins Advantage MD Plus (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic equipment is only partially covered under this plan, as diabetic therapeutic shoes and inserts are covered with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the Johns Hopkins Advantage MD Plus (PPO) plan, as lab services are not covered and prior authorization is required for all other services. Diagnostic procedures and tests require a 20% minimum coinsurance and no copay, while diagnostic radiological services incur a $250 minimum copay and no coinsurance. Outpatient x-rays require a $30 copay and coinsurance, and therapeutic radiological services carry a 20% minimum coinsurance alongside a copay.
Home Health Services See details
Johns Hopkins Advantage MD Plus (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Johns Hopkins Advantage MD Plus (PPO) with no copay and no coinsurance, although only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Johns Hopkins Advantage MD Plus (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $150 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the 100-day limit are not covered.
Other Services See details
Johns Hopkins Advantage MD Plus (PPO) provides partial coverage for other services, featuring acupuncture with no copay and no coinsurance up to a $200 annual limit. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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