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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 2025, 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 2025.
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 $0.00. 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 has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $20 copay for Tier 1 preferred generic drugs at a standard pharmacy or through mail order. You will pay 25% coinsurance for Tier 2 standard generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Johns Hopkins Advantage MD Primary (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $350 copay for days 1-5, and no copay for days 6-90. Outpatient services have varying copays, while primary care visits have a $10 copay. Preventive services, such as annual physical exams, are covered with no copay, and vision services include eye exams with a $0-$50 copay, and $200 annually for eyewear. The plan also covers ambulance and emergency services, with specific copays for each, as well as home health and skilled nursing facility services with no or low copays. Dental services are covered, and the plan offers up to $2,000 annually for orthodontic services. Additional benefits include coverage for home infusion bundled services, dialysis services, and medical equipment with coinsurance, and an OTC allowance of $50 every three months.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, the copay is $350 per admission, and there is no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, as well as non-Medicare covered stays and upgrades, are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a copay of $320, ambulatory surgical center services have a copay of $250, and individual and group sessions for outpatient substance abuse have a copay of $40.
Partial Hospitalization See details
Partial hospitalization is covered under the Johns Hopkins Advantage MD Primary (PPO) plan, but requires prior authorization. You will pay a $60 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Johns Hopkins Advantage MD Primary (PPO). Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance, and 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 under the Johns Hopkins Advantage MD Primary (PPO) plan, with copays of $110, $45, and $110 respectively, and no coinsurance. Worldwide Urgent Coverage is also covered with a $45 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Johns Hopkins Advantage MD Primary (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and physical therapy/speech-language pathology services with a $40 copay. Mental health specialty services and psychiatric services are covered with a $40 copay for individual and group sessions. Other health care professional services are covered with a copay between $0 and $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Johns Hopkins Advantage MD Primary (PPO) plan covers various preventive services, including Medicare-covered services and annual physical exams, with no copay. Kidney Disease Education Services have a copay of $15. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. This plan has a combined maximum plan benefit coverage of $200 every year for all eyewear. Upgrades are not covered.
Dental Services See details
The Johns Hopkins Advantage MD Primary (PPO) plan covers a variety of dental services, including oral exams, dental x-rays, cleaning, and fluoride treatment, with specific visit limitations. Orthodontic services are not covered, but the plan offers up to $2,000 annually for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Johns Hopkins Advantage MD Primary (PPO) plan. For Medicare Part B Insulin Drugs, you will pay a $35 copay, with coinsurance between 0-20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered. Diagnostic procedures and tests have no copay, but a coinsurance of at most 20%, while lab services are not covered. Diagnostic radiological services have a copay of $175, and therapeutic radiological services have a coinsurance of at most 20%. Outpatient X-ray services have a copay of $20.
Home Health Services See details
Home Health Services are covered by Johns Hopkins Advantage MD Primary (PPO), with no copay or 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 Primary (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 Primary (PPO). There is no copay for days 1-20, and a $196 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, covered up to $50 every three months, but does not cover all drugs on the CMS OTC list, as well as Acupuncture, Meal Benefit, 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.
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