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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 2025, 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 2025.
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 $135.00. 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 Plus (PPO) plan has a $590 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy, or 25% coinsurance for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. However, if you qualify for the low-income subsidy, your premium will be reduced. For those with the low-income subsidy, the monthly premium is $14.10.
Additional Benefits
The Johns Hopkins Advantage MD Plus (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll have a $330 copay for inpatient hospital stays for days 1-6, and no copay for days 7-90. Outpatient services have copays ranging from $40 to $320. The plan includes coverage for primary care, preventive services, hearing, vision, and dental. Primary care physician services have no copay, while specialist visits have a $40 copay. Hearing exams have a $40 copay, and prescription hearing aids are covered with copays between $699 and $999. Vision services offer eye exams with a $0-$40 copay, and dental services have 20% coinsurance for Medicare-covered services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. 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. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $320 copay, ambulatory surgical center services have a $250 copay, and individual and group substance abuse sessions have a $40 copay. Outpatient blood services include an enhanced benefit.
Partial Hospitalization See details
Partial Hospitalization is covered by the Johns Hopkins Advantage MD Plus (PPO) plan, but requires prior authorization. You will have a $50 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Johns Hopkins Advantage MD Plus (PPO). Ground and air ambulance services have a $210 copay with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Johns Hopkins Advantage MD Plus (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage has a $110 copay; all have no coinsurance. Worldwide Emergency Transportation is 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 Plus (PPO) plan. Primary Care Physician Services have no copay, Chiropractic Services have a $15 copay for some services, Occupational Therapy Services have a $30 copay, Physician Specialist Services have a $40 copay, and Physical Therapy and Speech-Language Pathology Services have a $30 copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions. Podiatry services have a 20% coinsurance and a $40 copay for routine foot care. Other Health Care Professional services have a copay between $0 and $40.
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 $10.00, while services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, and Routine Hearing Exams are covered once per year. Prescription hearing aids are covered with a copay between $699 and $999 for all types, but hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0 - $40 and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $150 every year. Upgrades are not covered.
Dental Services See details
Dental services offer 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, and prophylaxis (cleaning) are covered, but fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Johns Hopkins Advantage MD Plus (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Diabetic Equipment has a coinsurance for Medicare-covered Diabetic Supplies, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and outpatient X-ray services. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Diagnostic Radiological Services have a copay of $250.00, and Outpatient X-Ray Services have a copay of $30.00. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Johns Hopkins Advantage MD Plus (PPO) 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 Plus (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Johns Hopkins Advantage MD Plus (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $150. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, with a maximum benefit coverage amount of $200 per year. However, over-the-counter items, meal benefits, 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 are not covered.
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