Call 1-877-354-4611 TTY 711. The members plan determines which formulary applies: Advantage MD PPO/Plus PPO/Premier PPO FormularyAdvantage MD HMO FormularyAdvantage MD D-SNP (HMO) Formulary. With useful Medicare information delivered right to your inbox. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan has a $1,000 Annual Maximum. hbbd``b`z $s6qg$&7C $X@ I BHpG bKe+Hq$3012liHg O] Gap Coverage Phase. endstream endobj startxref How do I request a prior authorization for these services? Offered throughout most of Maryland, a Johns Hopkins Medicare Advantage plan provides you with comprehensive Medicare coverage including Medicare Part D drug coverage. 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. 0000789385 00000 n Use the resources on this site to help you get the most out of your Advantage MD plan. 0000000016 00000 n 8(Ly Please review the applicable formulary and corresponding cost sharing tiers (copays) to confirm coverage. 0 Doctors and staff can contact CVS/caremark by calling the number below, 24 hours a day, seven days a week. How to request a medical benefit drug prior authorization: All preferred and non-preferred Part B drugs are identified on the Advantage MD Part B Prior Authorization Drug list. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . Download the applicable Request for Medicare Prescription Drug Coverage Determination form below, complete, and send with clinical supporting documentation. 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. 0000789570 00000 n Advantage MD products are offered by Hopkins Health Advantage, Inc., a Maryland health insurer. This rejection will occur when prescribed drugs have the same therapeutic effects as medication(s) the Part D Enrollee is currently taking (i.e. 0000111903 00000 n Advantage MD is committed to delivering cost effective quality care to our members. Please note: the same drugs may not be in all formularies and the drugs may be on different tiers (Tier 2 vs. All members can access wellness programming, including free classes, care management, pregnancy support and more. 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. 10]J00}e0 *= Your Cost. Have Questions About Your Bill? 0000789520 00000 n 0000021832 00000 n 0000113685 00000 n This plan = Part A + Part B + Part D Plan Details Monthly Premium $30 Health Portion of Premium $12 0000012697 00000 n 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). 0000111707 00000 n Silver&Fit and the Silver Slate are federally registered trademarks of ASH and used with permission herein. 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. A top-tier PPO, which features comprehensive dental coverage, is only offered in Montgomery County. Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. 0000012071 00000 n Step Therapy requires preferred products be used prior to non-preferred agents. 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. 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. 0000022582 00000 n Contact customer service at 1-855-662-3017. The Comprehensive Formularies are complete lists of medications we cover and are approved by Medicare. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). You must have both Part A. Johns Hopkins OnDemand Virtual Care gives members 24/7 access to care for minor medical concerns. 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. 0000013598 00000 n Health Plan Radar. For specific information on your benefits, use our interactive tool to browse your covered benefits. 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. IMPORTANT : This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP). Coverage of these drugs are subject to specific criteria approved by Medicare. Certain medications require prior authorization before coverage is approved, to assure medical necessity, clinical appropriateness and/or cost effectiveness. *Please note: this information does not apply to AdvantageMDGroup. 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. Mon-Fri 8am-9pm EST . By signing the Agreement for Care Form, you agree that your Johns Hopkins Medicine health care provider can be paid directly by your insurance. This rejection will occur when interacting drug combinations are identified (i.e. 0000001716 00000 n 0000209468 00000 n 0 Find Plans | Get Facts. . Baltimore - December 8, 2016. 84 0 obj <>stream 0000088113 00000 n 0000085364 00000 n Download and complete the Request for Redetermination of Medicare Prescription Drug Denial form and send with clinical supporting documentation: Expedited appeal requests can be made by phone, 24 hours a day, seven days a week. . Advantage MD Part B Prior Authorization Criteria. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . Clinical documentation should be provided to support all requests. 0000111436 00000 n Quantity Exceptions can be requested when a medical condition warrants use of quantities greater than listed quantities for each drug. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. Some non-preferred generic drugs are also included. If HealthLINK is not able to be accessed, contact NovoLogix for assistance by calling: 800-932-7013. &/I&09LHH"8Hi{Xf$ @ yBF0 Hy Compare our Advantage MD plans with Original Medicare using the chart below, or use our interactive tool. Enroll on the phone or online! Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. 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. All rights reserved. 0000034857 00000 n For more information, please review the Evidence of Coverage. * Not available as extended days' supply (greater than 30 days' supply). LA - Limited Access, available only at certain pharmacies per manufacturers restriction. %%EOF I want to. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Get the Facts on Medicare . 0000002545 00000 n 167 0 obj <>stream 0000035096 00000 n 0000121585 00000 n Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Additional Coverage. hb``g``4Ab@c,-::8d$K'1D=E-e\ =lDfg Q N)%0EnL ov A 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. Wellness Programs. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD (HMO) offered by Johns Hopkins Advantage MD. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. Certain medications are required to satisfy specific step therapy criteria. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security. 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. 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). 0000120547 00000 n Enrolling is quick and easy. 0000209171 00000 n Questions About Dental Benefits? EHP/Priority Partners/Advantage MD patients, NM - Not available at mail-order pharmacies. 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. Medicare Advantage combines Part A and Part B. 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. Notice of Nondiscrimination: Johns Hopkins Advantage MD (PPO) and Johns Hopkins Advantage MD (HMO) comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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