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Maintenance medication on cost sharing tier 1 may be obtained for a 100 day supply and medications on cost sharing tier 2 through tier 4 may be obtained for a 90 day supply. 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. 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. Members are responsible for the difference between the allowed amount and the billed amount. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. PPO Step Therapy CriteriaHMO Step Therapy CriteriaD-SNP (HMO) Step Therapy Criteria. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. LA - Limited Access, available only at certain pharmacies per manufacturers restriction. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. 31 - Monday through Sunday, 8 a.m. to 8 p.m. and Apr.1 through Sept. 30 - Monday through Friday, 8 a.m. to 8 p.m. If you want a Provider or Pharmacy Directory mailed to you, or if you need help finding an in-network provider, please call Customer Service, October 1 through March 31, Monday through Sunday, 8 a.m. to 8 p.m., and April 1 through September 30, Monday through Friday, 8 a.m. to 8 p.m. PPO network: call 877-293-5325 (TTY: 711) HMO network: call . Medicare Advantage plan information for Johns Hopkins Advantage MD (HMO) by Johns Hopkins HealthCare. 10]J00}e0 *=
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You must have both Part A. Johns Hopkins Advantage MD is available to residents of these counties: document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); I would like a representative to call me to speak about questions regarding enrolling in a plan. To find if a drug requires a Step Therapy and criteria, please refer to the appropriate formulary/formulary search tool. Advantage MD Part B Prior Authorization Criteria.
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Gap Coverage Phase. 0000788916 00000 n
Johns Hopkins Advantage MD Plus (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. Learn more about Medicare Part A - Hospital Insurance. Those having their benefits terminated will lose access to reduced prices for prescriptions, better copays, and access to vision and dental benefits. 0000085838 00000 n
Medicare plans are available to all Medicare beneficiaries. 0000113685 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. 0000121585 00000 n
1 in the medicare advantage (ma) program, which currently covers just over a third of medicare beneficiaries, plans are able to offer supplemental coverage Johns Hopkins Advantage MD Medicare Advantage Plans with Part D Medicare Health Speak to a Licensed Insurance Agent 833-835-0205 Mon-Fri 7am-10pm, Sat 10am-7pm ET | TTY/TDD #711 Shop. 0000113770 00000 n
With so many benefits, it's important to understand your Advantage MD coverage to get the most out of your health care. Whole Health Assessment Form Whole Health Assessment (Online Form) PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. Submit your request electronically, by using the online. Advantage MD is committed to delivering cost effective quality care to our members. . CVS/caremark mail order pharmacy provides mail order requests to members. The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $500 Annual Maximum. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. %PDF-1.7
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Step Therapy requires preferred products be used prior to non-preferred agents. 0000111707 00000 n
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Johns Hopkins Advantage MD (PPO) Medicare Plan Details (2023 Plan) Monthly Premium . Cost Sharing Tier 4: Non-Preferred Drugs have a higher out-of-pocket cost for members. Search for a Provider. %%EOF
Enroll . Cost savings will apply to a select list of insulin products during the initial and coverage gap stages. Compare our Advantage MD plans with Original Medicare using the chart below, or use our interactive tool. Our formularies are updated on a monthly basis or whenever formulary changes occur. 8(Ly Use the resources on this site to help you get the most out of your Advantage MD plan. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. $30 by Johns Hopkins Advantage MD. Every October we offer an open enrollment period where you can switch plans, add or remove family members, or opt in or out of coverage. Don't forget that new CMS regulations require disclosures . Member cost share for Select Insulins will be $35 for a one-month supply and up to $105 for a three-month supply with additional savings for mail order. All rights reserved. Your Cost. Certain medications have specific dispensing limitations for quantity and maximum dose. View recent announcements. Advantage MD Premier (PPO) and Advantage MD D-SNP (HMO) You get all the beneits of a comprehensive dental plan included in your premium. 0[D1`_`2A3w "
The following section will describe these benefits in detail. Download Female dentist examining patient with dental assistant, Munich, Bavaria, Germany Stock Photo and explore similar images at Adobe Stock. 0000033996 00000 n
Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prior Authorization, Quantity Limits, and Step Therapy, Select Insulins for Reduced Copays New 2022 Benefit, Over the Counter Program New 2022 Benefit, Advantage MD PPO/Plus PPO/Premier PPO Formulary, PPO/Plus PPO/Premier PPO Errata (list of formulary changes), D-SNP (HMO)Errata (list of formulary changes), PPO/Plus PPO/Premier PPO formulary search tool, Request for Medicare Prescription Drug Coverage Determination form, PPO Prescription Drug Coverage Determination Request, HMO and D-SNP Prescription Drug Coverage Determination Request, HMO and D-SNP Step Therapy Exception Request, HMO and D-SNPQuantity Limit Exception Request, HMO and D-SNPFormulary Exception Request, PPO Prescription Drug Coverage Redetermination Request, HMO Prescription Drug Coverage Redetermination Request, specific codes require prior authorization or have step therapy, Advantage MD Part B Prior Authorization Drug. 0000034414 00000 n
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Oct. 1 through Mar. *Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. hb``g``4Ab@c,-::8d$K'1D=E-e\
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%%EOF
Search health topics in theHealth Library. The Comprehensive Formularies are complete lists of medications we cover and are approved by Medicare. hbbd``b`z $s6qg$&7C $X@ I BHpG bKe+Hq$3012liHg O]
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Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Please consider prescribing generic blood pressure, cholesterol, and diabetes medications as 100-day supplies to help your patients save money and improve their adherence. Specialty Tier drugs have a coinsurance and are limited to a 30 day supply. Johns Hopkins Advantage MD PPO, Advantage MD Plus PPO, Advantage MD Premier PPO, . 0000021832 00000 n
Mon-Fri 8am-9pm EST . 0000034551 00000 n
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LifeBridge Health, along with five other of the region's most notable health systems, recently became an equity partner in Johns Hopkins Medicare Advantage health plans, making LifeBridge Health a part owner of the Hopkins Medicare managed insurance plans Advantage MD and Advantage MD Plus. trailer
10,000+ Maryland Providers Variety of Medicare Plans Advantage MD Care Team Johns Hopkins Advantage MD (PPO) Frequently Asked Questions Provider Relations Department: 1-888-895-4998 . 0000208904 00000 n
Step Therapy Exceptions can be requested when there is contraindication to the prerequisite medication or there is documented trial and failure of prerequisite medication. $200 supplemental benefit for any injury or illness. Johns Hopkins Advantage MD administers Part D Pharmacy Benefits for the following members: FormulariesCost Sharing TiersPrior Authorization, Quantity Limits, and Step TherapySelect Insulins for Reduced Copays New 2022 BenefitExceptionsAppeals (Redetermination)Opioid EditsMedical InjectablesOver the Counter Program New 2022 Benefit. Contact us or find a patient care location. The Johns Hopkins Medicare Advantage Plans are still the only Medicare Advantage Plans accepted at the renown Johns Hopkins Health Care system. Please note: the information in this section does not apply to AdvantageMD Group. Call 1-877-354-4611 TTY 711. Enroll on the phone or online! Wellness Programs. It will cost $301 per month in 2022. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. About Johns Hopkins Medicine. Overall Government Star Rating 3.0 . You can join a participating Silver&Fit fitness center in our service area at no charge and take advantage of all of the services and amenities that are included as part of your basic fitness center membership. Additional Coverage. 0000034145 00000 n
Advantage MD products are offered by Hopkins Health Advantage, Inc., a Maryland health insurer. 0000209939 00000 n
0
For detailed information on what each individual plan offers, visit benefits.hopkinsmedicare.com, or see the summary of benefits: Diabetes testing supplies are covered under Medicare Part B. GC - We provide additional coverage of this prescription drug in the coverage gap. &/I&09LHH"8Hi{Xf$ @ yBF0 Hy
If you have any questions, call Customer Service: PPO patients: 877-293-5325 (option 2)HMO and D-SNP patients: 877-293-4998 (option 2). Enter the last name, specialty or keyword for your search below. 0000028930 00000 n
Providers have access to the prior authorization system that allows for intake through a web-based portal, as well as access to real-time status updates. 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. Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. 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. How do I request a prior authorization for these services? Advantage MD recently launched the Johns Hopkins Advantage MD Benefits Explorer, an interactive tool designed to help Advantage MD members quickly and easily find coverage information related to specific services. Cost Sharing Tier 3: Preferred Brand Drugs have an intermediate out-of-pocket cost for members. *Please note: this information does not apply to AdvantageMDGroup. The plans website includes apharmacy locator for members and providers to easily locate participating pharmacies. This page features plan details for 2023 Johns Hopkins Advantage MD D-SNP (HMO D-SNP) H1225 - 003 - 0 available in Anne Arundel, Howard and Montgomery Counties. Hearing Vision Dental. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). Submit the prior authorization request or the step therapy exception utilizing Advantage MDs HealthLINK Secure Provider Portal. Masks are required inside all of our care facilities. 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. Advantage MD utilizes multiple formularies. 0000013598 00000 n
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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. PPO/Plus PPO/Premier PPO Errata (list of formulary changes)HMO Errata (list of formulary changes)D-SNP (HMO)Errata (list of formulary changes). If you choose to provide us with personal information by sending an email, or by filling out a form with your personal information and submitting it through our Web site, we use that information to respond to your message and to help us provide you with information or material that you request. Advantage MD plans will now allow 100-day supplies on Tier 1 maintenance medications for the same cost as a 90-day supply. All Medicare Advantage and Part D Plans Facts . 0000789385 00000 n
$300 supplemental benefit for any injury or illness.
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. Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. Only non-Low Income Subsidy (LIS) enrollees are eligible for the reduced cost-sharing. Advantage MD utilizes multiple formularies. For more information, please review the Evidence of Coverage. Employees may choose to opt out of receiving dental coverage. If it is listed as a Preferred Product, it does not require step therapy. 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. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. 63 0 obj
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<. If the drug is not listed, it does not require prior authorization. You can also download a PDF of your plan's summary of benefits. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. Nearly 6,000 seniors will lose coverage. How do I determine if a specific treatment requires prior authorization or has step therapy? * Amenities offered by fitness centers vary by location. Phone Directory Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. This rejection may be overridden by the pharmacist but they may contact the prescriber for confirmation. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . Providers should discuss all OTC products with their patients but do not need to submit anything to the plan. Offered throughout most of Maryland, a Johns Hopkins Medicare Advantage plan provides you with comprehensive Medicare coverage including Medicare Part D drug coverage. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD (HMO) offered by Johns Hopkins Advantage MD. The searchable formulary may not include all covered drugs. endstream
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Formulary changes will be reflected in the updated formularies and in the formulary changes lists below. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! 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. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. Select Insulins:BASAGLAR KWIKPENFIASP, FIASP FLEXTOUCH, FIASP PENFILLLEVEMIR, LEVEMIR FLEXTOUCHNOVOLIN 70/30, NOVOLIN 70/30 FLEXPENNOVOLIN N, NOVOLIN N FLEXPENNOVOLIN R, NOVOLIN R FLEXPENNOVOLOG MIX 70/30, NOVOLOG 70/30 FLEXPEN, NOVOLOG MIX 70/30 PREFILLNOVOLOG, NOVOLOG FLEXPEN, NOVOLOG PENFILLSOLIQUA 100/33TRESIBA,TRESIBA INJ, TRESIBA FLEXTOUCHXULTOPHY 100/3.6HUMULIN R U-500, HUMULIN R U-500 KWIKPEN (30-day supply only). Clinical documentation should be provided to support all requests. The network includes most chain retailers and independent pharmacies. The provider may request an exception to the step therapy for specific circumstances that warrant a need for a non-preferred product. 2. This dental checkup usually takes an hour or less to complete Your visit may include (depending on your benefits): Cleaning and polishing X-rays 0
Browse provider manuals. Cumulative Morphine Milligram Equivalent (cMME) Edit (aka Care Coordination Edit), This rejection will occur if the cMME dose is. 0000024083 00000 n
These point-of-sale edits are safety edits and not intended as prescribing limits. Tier 3). 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. Initial Coverage Phase After you pay your deductible, if applicable, up to the initial coverage limit of $4,430. Dental Checkup - Johns Hopkins Advantage MD Enroll Now Dental Checkup What is this visit? Contact JHHC. 97 71
All members can access wellness programming, including free classes, care management, pregnancy support and more. list for the requested drug criteria. Additional Coverage. Access Provider Resources. 0000085811 00000 n
Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. Personally Provided Information Supplies like meters, lancets, and test strips can be purchased at a network pharmacy, but nebulizers and other equipment must be purchased through a DME vendor. 0000025382 00000 n
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. 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. If you have questions about Johns Hopkins Advantage MD or require assistance in selecting a PCP, please call our Customer Service Department at 1-877-293-5325.
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