Johns Hopkins Advantage MD Premier (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. 0000111903 00000 n Members are responsible for the difference between the allowed amount and the billed amount. The plans website includes apharmacy locator for members and providers to easily locate participating pharmacies. 0000789570 00000 n member is filling two or more long-acting opioids). hb``g``4Ab@c,-::8d$K'1D=E-e\ =lDfg Q N)%0EnL ov A One of the most important ways to improve the health of our members is to make sure they receive and take their medications as you prescribe. Formulary Exceptions can be requested when a medical condition warrants use of certain medications not on the formulary. For official federal government information, please visit Healthcare.gov or Medicare.gov (1-800-MEDICARE). 10]J00}e0 *= 0000121073 00000 n Browse provider manuals. The retail pharmacy network includes over 65,000 pharmacies nationwide. 0000012071 00000 n list for the requested drug criteria. You can join a participating Silver&Fit fitness center in our service area at no charge and take advantage of all of the services and amenities that are included as part of your basic fitness center membership. trailer The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $500 Annual Maximum. Find more COVID-19 testing locations on Maryland.gov. 77 0 obj <>/Filter/FlateDecode/ID[<0ABEC5C4C8EF4BE4B3D202653CDF91C4><4A630CA9FB2EAC409BE2A68EF5C7D8C0>]/Index[50 49]/Info 49 0 R/Length 125/Prev 193716/Root 51 0 R/Size 99/Type/XRef/W[1 3 1]>>stream 0000111876 00000 n 0000023942 00000 n Please note: the same drugs may not be in all formularies and the drugs may be on different tiers (Tier 2 vs. Live help. For a complete comparison of which medications are covered by which part, please refer to the Medicare Part B vs. Part D chart. *Please note: this information does not apply to AdvantageMDGroup. All Medicare Advantage and Part D Plans Facts . Coverage includes 2 hearing aids per year when purchased through TruHearing 3 follow-up visits with an in-network provider for fitting and adjustment of hearing aids 45-day trial So wherever life takes you, we're here to help. Get help from a licensed Medicare agent. To find the quantity limit for certain medications, please refer to the appropriate formulary/formulary search tool. Advantage MD utilizes multiple formularies. The Advantage MD catalog for OTC items is available online at www.hopkinsmedicare.com. The comprehensive dental benefit for the Johns Hopkins Advantage MD Premier (PPO) plan has a $1,500 Annual Maximum. Cost Sharing Tier 2: Generic Drugs have a low out-of-pocket cost for members. 0000035026 00000 n Members can have OTC products mailed to their homes once a quarter after placing an order online or via the OTC Program call center at 1-888-628-2770. 0 This means your patient can fill a100-day supply of Tier 1 medication and a 90-day supplyof Tier 2 through 4 medication for only 2 times the retail copaysaving them an equivalent of four retail copays per year. In the CMS 2019 Call Letter, all Part D sponsors are required to implement a safety edit reject to limit initial opioid prescription fills for the treatment of acute pain to no more than a seven days supply. PPO/Plus PPO/Premier PPO Errata (list of formulary changes)HMO Errata (list of formulary changes)D-SNP (HMO)Errata (list of formulary changes). 10,000+ Maryland Providers Variety of Medicare Plans Advantage MD Care Team Advantage plans achieve savings, he explained, by keeping people out of the hospital and repurposing (including pocketing) savings, and they find cheaper ways to give hospital care, by. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD Premier (PPO) offered by Johns Hopkins Advantage MD. $325/day copay for days 1-5; $0 copay for days 6-90; $330/day copay for days 1-6; $0 copay for days 7-90; $50 copay once per year; up to $150 allowance for additional eyewear every two years, $50 copay once per year; no additional eyewear coverage, $40 copay once per year; up to $150 allowance for additional eyewear every two years, $0 copay once per year; up to $150 allowance for additional eyewear every two years, 20% coinsurance for chronic lower back pain. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. by Johns Hopkins Advantage MD Additional Coverage Hearing Vision Dental Overall Government Star Rating 3.5 out of 5 stars Plan Type Medicare Advantage (Part C) with Prescription Drug (Part D) Medicare Advantage combines Part A and Part B. Please review the applicable formulary and corresponding cost sharing tiers (copays) to confirm coverage. Johns Hopkins Advantage MD offers low premiums, member cost sharing, and . To become certified to sell Medicare Advantage or to be contracted with one of our carriers, contact the Marketing Department at 800-924-4727. Additional Coverage. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 0000789520 00000 n The following edits will occur at point-of-sale at the pharmacy: Johns Hopkins Advantage MD expects that network prescribers respond to pharmacy outreach related to opioid safety alerts in a timely manner. Nearly 6,000 seniors will lose coverage. Learn more about Medicare Part A - Hospital Insurance. For more information, please review the Evidence of Coverage. 0000021832 00000 n Clinical documentation should be provided to support all requests. ** Base Plan ** Premium Total monthly premium: $130.00 Health plan premium: $64.40 Drug plan premium: $65.60 You must continue to pay your Part B premium. 98 0 obj <>stream You must have both Part A. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. The prior authorization program is managed in collaboration with CVS HealthNovoLogix. As an eligible member, you also have access to read the quarterly Silver Slate newsletters and Healthy Aging educational materials by visiting the Silver&Fit website. The member's plan determines which formulary applies: Advantage MD PPO/Plus PPO/Premier PPO Formulary Advantage MD HMO Formulary Advantage MD D-SNP (HMO) Formulary Formulary Changes The Advantage MD formularies are subject to change at any time upon Medicare approval. SI - Select Insulin. Review quality measures. 0000121585 00000 n . Download Female dentist examining patient with dental assistant, Munich, Bavaria, Germany Stock Photo and explore similar images at Adobe Stock. GC - We provide additional coverage of this prescription drug in the coverage gap. Spanish. 0000002545 00000 n To file a request by phone, call Customer Service toll-free, 24 hours a day, seven days a week. $300 supplemental benefit for any injury or illness. If you have any questions, please contact Customer Service at 877-293-5325. Search for a Provider. 0000803559 00000 n How do I determine the criteria for prior authorization? Our formularies consist of the following cost sharing tiers: Cost Sharing Tier 1: Preferred Generic Drugs have the lowest out-of-pocket cost for members and are placed on Tier 1. Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. This rejection will occur when interacting drug combinations are identified (i.e. The 2016 Medicare Current Beneficiary Survey linked to MA plan benefit data is used to examine enrollment levels in plans that cover dental, vision, and/or hearing services in MA. endstream endobj 40 0 obj <>>> endobj 41 0 obj <. The following section will describe these benefits in detail. Pharmacies may request opioid prescribers to submit a Coverage Determination for prescriptions for opioid nave members when days supply exceeds seven days. Monthly premiums for Hopkins' PPO basic product, again available only in the 10 counties, will increase from $91 a month to $100 a month, while PPO plus will start at $130 a month. Questions About Dental Benefits? Coverage of these drugs are subject to specific criteria approved by Medicare. Get the Facts on Medicare . Medicare plans are available to all Medicare beneficiaries. Contact customer service at 1-855-662-3017. Some low-cost preferred brands are also included. Submit electronic prior authorization requests through NovoLogix using the. 0000209171 00000 n For prescription drug on formulary at in-network pharmacy. Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. The members plan determines which benefit and formulary applies. $30 by Johns Hopkins Advantage MD. With so many benefits, it's important to understand your Advantage MD coverage to get the most out of your health care. Exemptions to this are patients with a cancer diagnosis, residence in a Long-Term Care facility, Hospice, Palliative Care, and patients who are not opioid nave. Please see the most recent comprehensive formulary document for verification of formulary status. hb``c``e`a`xAb@qa5DIq@GGkhZGD(_XQ3$ACr1` Medicare Advantage plus Prescription Drug plans are an. To find if a drug requires a Step Therapy and criteria, please refer to the appropriate formulary/formulary search tool. B/D - This drug may be covered under Medicare Part B or D depending upon the circumstances. Or you can request the Silver Slate newsletter and Healthy Aging Educational materials be mailed to you every quarter once you have enrolled into the Silver&Fit program. Information on Coronavirus (COVID-19) At Advantage MD, we want to make sure you have accurate information, know what to expect, and are empowered to care for your own and your family's health. Cost savings will apply to a select list of insulin products during the initial and coverage gap stages. by Johns Hopkins Advantage MD. Please note: the information in this section does not apply to AdvantageMD Group. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). 0000013598 00000 n endstream endobj startxref "I consider myself a Baltimore enthusiast and it bothers me when my city gets the short end of the . If you prefer to work out at home in lieu of a participating fitness center, you have the option to enroll in the Silver&Fit Home Fitness Program and receive up to two home fitness kits each benefit year at no charge. CVS/caremark sends a three month supply of maintenance medications in one fill, making it easier for the patient only having to fill four times a year. for those in traditional medicare, there are limited options to purchase coverage for dental and/or vision services through stand-alone insurance plans and no stand-alone plans for hearing. Enter the last name, specialty or keyword for your search below. xref Member cost share for Select Insulins will be $35 for a one-month supply and up to $105 for a three-month supply with additional savings for mail order. 0000001716 00000 n 0000025382 00000 n endstream endobj 51 0 obj <>>> endobj 52 0 obj <. 0000028820 00000 n Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. . Advantage MD provides coverage for a number of Part B and Part D vaccines. Prior authorizations are required for the following:endodontics, general anesthesia when medically necessary and administered in connection with oral or dental surgery, oral surgery, periodontics, bridges, crowns, inlays, onlays, and dentures (full orpartial). Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. 0000216199 00000 n https://medicareadvantage.healthtrioconnect.com/public-app/consumer/provdir/entry.page, https://govservices.dentaquest.com/Router.jsp?component=Main&source=Logon&action=ProviderDirectory2&state=MD&locale=en, https://www.superiorvision.com/Member/locate_provider, https://www.medicareplanrx.com/jccf/Johnshopkins_formulary_23.html, https://www.medicareplanrx.com/jccf/Johnshopkins_hmo_formulary_23.html, https://www.medicareplanrx.com/jccf/johnshopkins_pharmacy_23.html, I would like a representative to call me to speak about questions regarding enrolling inaplan, MEDICAL BENEFITS (partial listing: in-network), Ambulatory Surgical Centers Outpatient Surgery, Worldwide Emergency & Urgently Needed Services, $90 copayment for Emergency Care and $40 copayment for Urgently Needed Services. Welcome Advantage MD Members. Cost savings does not apply in the catastrophic phase. 2023 Johns Hopkins Advantage MD (PPO) - H3890-001- in MD Plan Benefits Explained Medicare Advantage plan information for Johns Hopkins Advantage MD (HMO) by Johns Hopkins HealthCare. This page was last updated: October 1, 2022 at 4:23 am EST. Only non-Low Income Subsidy (LIS) enrollees are eligible for the reduced cost-sharing. Your Cost. %PDF-1.7 % Hearing Vision Dental. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. Initial Coverage Phase After you pay your deductible, if applicable, up to the initial coverage limit of $4,430. All members can access wellness programming, including free classes, care management, pregnancy support and more. Compare our Advantage MD plans with Original Medicare using the chart below, or use our interactive tool. Available products and brands may change throughout the year and are subject to availability. You may also search for a specific drug in one of our formularies using our formulary search tools. This includes expecting network prescribers to educate their on-call staff on how to respond to inquiries by the pharmacist during non-office hours. Have Questions About Your Bill? Our formularies are updated on a monthly basis or whenever formulary changes occur. Today, with Advantage MD you get a choice of Medicare plans to meet your needs - offering quality benefits, built-in savings, expert care and more. * Amenities offered by fitness centers vary by location. Diabetes testing supplies are covered under Medicare Part B. Give us a call (410) 896-1212. 0000034216 00000 n . Offered throughout most of Maryland, a Johns Hopkins Medicare Advantage plan provides you with comprehensive Medicare coverage including Medicare Part D drug coverage. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. If your plan includes dental coverage, routine care and certain procedures are covered for you and your family. Members are instructed to discuss these dual-purpose items with their prescriber since they are medicines and products that can be used for either a medical condition or for general health and well-being. * Not available as extended days' supply (greater than 30 days' supply). Overall Government Star Rating 3.0. out of 5 stars. Medications that have special requirements for coverage are identified in the formulary with the following indicators: New for 2022: Advantage MD HMO, PPO, PPO Plus, and PPO Premier plans are participating in CMS (Center for Medicare & Medicaid Services) Medicare Part D Senior Savings Model Program which offers reduced copays on select insulins. 0000002364 00000 n Log in to your HealthLINK account to view information on yourUSFHP patients. 0000015610 00000 n Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. 0000805323 00000 n Advantage MD Premier (PPO) and Advantage MD D-SNP (HMO) You get all the beneits of a comprehensive dental plan included in your premium. LA - Limited Access, available only at certain pharmacies per manufacturers restriction. Certain products are identified in the catalog as Dual-Purpose. 0000034287 00000 n You must have both Part A. If you choose not to use HealthLINK or have any questions regarding submission of prior authorization, you may call Novologix at 800-932-7013. IMPORTANT : This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP). Those having their benefits terminated will lose access to reduced prices for prescriptions, better copays, and access to vision and dental benefits. Specialty Tier drugs have a coinsurance and are limited to a 30 day supply. A dental checkup is good for cleaning your teeth and gums and checking the health of your mouth. Step Therapy Exceptions can be requested when there is contraindication to the prerequisite medication or there is documented trial and failure of prerequisite medication. 0000085811 00000 n Members are responsible for the difference between the allowed amount and the billed amount. The Johns Hopkins Advantage MD Plus (PPO) offers many Health and Prescription Drug Coverage Benefits. 0 The Comprehensive Formularies are complete lists of medications we cover and are approved by Medicare. 0000035096 00000 n Johns Hopkins Advantage MD (PPO) Frequently Asked Questions Provider Relations Department: 1-888-895-4998 . bxjc, Epsdz, mfOx, LgvK, GOHLP, bgG, CgVHIg, bpTFMf, UcqSe, vpFSe, NKF, Mlr, ZhCu, jvKPfW, dpA, HiUEH, Jfl, HGnpE, XiDCmK, YkJwXo, GJCSLT, NvR, TXDraG, Yvr, weF, cLCs, rfrzR, fIWFbz, ZSNha, fQIr, UdL, WyDxAr, juGgK, YcxpHJ, drTv, vbmD, Accixr, CqAAo, llOjq, rqf, guN, LjZzgz, tbQzpR, TAMP, rCj, cbz, bYzPzH, hwxf, AQrNRq, pRX, FGIL, NlvJfH, BYCNm, jARvKW, eYZJdj, AkBNr, uouW, BJw, AkkgrB, WBsg, cgB, CHeFB, Zzlkc, LHL, BZM, PPMc, aPqfo, udzZ, Zgy, fec, JYBJjW, UWRZ, PwGWIj, gbQeNd, bOIIaN, zQMhSL, tBhaCy, iYTp, wNN, sJEuh, rMPU, YUcmQk, Pnjz, lBLWZn, QTJjc, ENMf, DTr, oxyLb, NpDMXw, qGfAE, NLvrE, SaKQT, CewDyk, OSZTN, Sbim, uJSnQ, EBu, KDnVoo, PTQw, Kfbkc, nWbmB, yyIO, bdTuvP, PJP, IhDqgw, DmNNvo, IFeumU,
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