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Johns Hopkins Advantage MD Primary (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD Primary (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 Primary (PPO) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD Primary (PPO) is a PPO plan offered by Johns Hopkins Healthcare LLC available for enrollment in 2025 to people living in AA BL FR HW MO. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Johns Hopkins Advantage MD Primary (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 Primary (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 Primary (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.00. 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 has a $950.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 Primary (PPO) plan features a $590 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs are highly affordable, with standard copays starting at $6 for a one-month supply and capping at $12 for a three-month supply. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply, though standard mail order offers a reduced $67.50 copay for a two-month supply. For higher-tier medications, Tier 4 non-preferred drugs require a 25% coinsurance, while Tier 5 specialty tier drugs carry a 26% coinsurance for a one-month supply.
Additional Benefits
The Johns Hopkins Advantage MD Primary (PPO) plan provides comprehensive medical coverage with no copay for telehealth services and a low $10 copay for primary care visits. Specialist office visits carry a $45 copay, while emergency room visits require a $115 copay which is waived upon admission. For hospitalizations, inpatient stays require a $350 daily copay for days one through five and no copay for days six through 90. In addition to medical care, members benefit from no copay on home health services, routine preventive care, and basic dental services like cleanings and oral exams. Vision benefits include routine exams with a $0 to $50 copay and up to $150 for eyewear with no copay. Skilled nursing facility stays also feature no copay for the first 20 days, though specialized services like acupuncture, routine hearing exams, and over-the-counter items are not covered.
Inpatient Hospital See details
Johns Hopkins Advantage MD Primary (PPO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Johns Hopkins Advantage MD Primary (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 services require a $40 copay per session with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Johns Hopkins Advantage MD Primary (PPO) with a $60.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Johns Hopkins Advantage MD Primary (PPO) covers ground ambulance services with a $270 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Although transportation services are technically listed as covered, transportation to plan-approved or any health-related locations is not covered in practice.
Emergency Services See details
Johns Hopkins Advantage MD Primary (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with matching copays and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Johns Hopkins Advantage MD Primary (PPO) covers primary care visits for a $10 copay and specialist visits for a $45 copay, both with no coinsurance. Physical, occupational, speech, and mental health therapies are covered with copays ranging from $35 to $40 and no coinsurance, while telehealth services have no copay and no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Johns Hopkins Advantage MD Primary (PPO) partially covers preventive services, offering annual physical exams, routine screenings, and select fitness benefits with no copay and no coinsurance. Kidney disease education is covered with a $15 copay and no coinsurance, while several supplemental services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Johns Hopkins Advantage MD Primary (PPO) offers partially covered hearing exams with a $50 copay, no coinsurance, and no deductible, though routine hearing exams and fitting or evaluation for hearing aids are not covered. While some prescription hearing aid services are covered, all types—including inner ear, outer ear, and over the ear devices—and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Johns Hopkins Advantage MD Primary (PPO), as upgrades and other eye exam services are not covered. Routine eye exams carry a $0 to $50 copay and no coinsurance, while covered eyewear has no copay and no coinsurance up to a $150 annual maximum.
Dental Services See details
Johns Hopkins Advantage MD Primary (PPO) partially covers dental services with no copay and no coinsurance for Medicare-covered dental, oral exams, dental x-rays, cleanings, and fluoride treatments. Specialized services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and other diagnostic or preventive dental services, are not covered.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD Primary (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Johns Hopkins Advantage MD Primary (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Johns Hopkins Advantage MD Primary (PPO) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because diabetic therapeutic shoes and inserts are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Johns Hopkins Advantage MD Primary (PPO) partially covers diagnostic and radiological services with prior authorization required, though lab services are not covered. Covered diagnostic tests require a 20% coinsurance with no copay, outpatient X-rays require a $20 copay and a coinsurance, diagnostic radiological services carry a minimum $175 copay with no coinsurance, and therapeutic radiological services require both a copay and a 20% coinsurance.
Home Health Services See details
Johns Hopkins Advantage MD Primary (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 Primary (PPO) with no copay, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation with a 30% coinsurance, 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 Primary (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, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are covered under the Johns Hopkins Advantage MD Primary (PPO) plan, but in practice, some services are covered while acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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