8am - 6pm. We may immediately remove a brand name drug on our Drug List if, at the same time, we replace it with a new generic drug on the same or lower cost sharing tier and with the same or fewer restrictions. Details coverage for Johns Hopkins Advantage MD Johns Hopkins Advantage MD Tribute (HMO) in Maryland. Search for policies. View recent announcements. Search for a Provider. Benefits may vary by carrier and location. This is a 3-star Medicare Advantage plan without Part D (prescription drug) coverage. Download the comprehensive formulary or use our formulary search tool to find drugs that are covered by Advantage MD: We include formulary alternatives in the formulary search toolto help you and your prescribing doctor determine the proper course of action to take when one of yourmedicationsis not covered by your plan. Johns Hopkins Advantage MD covers both Medicare Part B and Part D medications. Please contact your provider to determine next steps. 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. Not all plans offer all of these benefits. also provides the following benefits. Review quality measures. To help your doctor decide whether to prescribe a formulary alternative, please download and print your plans comprehensive formulary and take it with you when you visit your doctor. U.S. News does not have a relationship with, or receive remuneration from Johns Hopkins Advantage MD. Your provider may request an exception to the step therapy for specific circumstances that warrant a need for a non-preferred product. 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. See reviews, photos, directions, phone numbers and more for John Hopkins Community Physicians locations in Downingtown, PA. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. You can also submit and check the status of claims through HealthLINK@Hopkins, the secure, online Web portal for JHHC providers and Priority Partners, EHP and . As a renewing or continuing member, you will receive your Annual Notice of Change (ANOC) by September 30. How this plan performs for drug pricing, patient safety, member experience and more. Use our pharmacy locator tool to find a pharmacy in your area where you can get your prescriptions, or skip the trip and have your prescriptions mailed to your home through our mail order pharmacy program: If you need help finding a PPO network pharmacy, please call us toll-free at 877-293-5325(TTY:711). From April 1September 30, you will need to leave a message on weekends and holidays. Yes No. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. English | A copy of your Medicaid card, which includes your name and the eligibility date. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. Would you like to continue? 8 a.m.-8 p.m., 7 days a week. ? Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. All rights reserved | About | Contact | Legal and Privacy, Johns Hopkins Advantage MD D-SNP (HMO D-SNP). This field is for validation purposes and should be left unchanged. This page was last updated: October 14, 2022 at 8:56 pm EST. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. We know prescription drug coverage is very important to you. See the appropriate fax number on the top of the form for submission. Whole Health Assessment Form. Click to Call 1-877-354-4611 TTY 711. O'Brien Johns. When you receive a transition fill letter, you should speak to the plan and/or your physician regarding whether you should change the drug you are currently taking, or request an authorization or exception from the plan to continue coverage of this drug. For prescription drug on formulary at in-network pharmacy. Unless you obtain an authorization or exception, we cannot continue to pay for these medications under the transition policy, even if you have been a member for less than 90 days following your 30-day transition supply. Current Members: . 8am - 6pm. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. After you pay your $505.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. If your Johns Hopkins Medicine hospital doesn't participate with a Medicare Advantage Plan, you can use out-of-network benefits if your . If you were taking a non-formulary drug or a prescription drug with a Step Therapy or a Prior Authorization restriction before you joined Johns Hopkins Advantage MD and you reside in a Long Term Care facility, the pharmacist who refills your prescription will be able to provide you with up to a 31-day supply of your prescription drug unless you have a prescription written for fewer days during the first 90 days of your membership in our plan. Important Message About What You Pay for Vaccines Our plan covers most Part D vaccines at no cost to you. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare . Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. When your annual out-of-pocket costs exceed $6,350. Your Part B premium may differ based on factors including late enrollment, income, and disability status. provides the following cost-sharing on drugs. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! Details drug coverage for Johns Hopkins Advantage MD Johns Hopkins Advantage MD (HMO) in Maryland. Enrollment in plans depends on contract renewal. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Once Advantage MD reviews the request, you will be notified of the decision via phone and mail. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) You are about to leave the Johns Hopkins Advantage MD website. The following Johns Hopkins Advantage MD plans offer Medicare Advantage Prescription Drug plan coverage to Maryland residents. You are about to leave the Johns Hopkins Advantage MD website. Once you reach that amount, you will enter the next coverage phase. 12pm - 5pm. Look up plan benefits. We do not offer every plan available in your area. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. You may also qualify for Extra Help on drug costs. Online Research Consultation. We are available 24 hours a day, seven days a week. If we make a coverage decision and you are not satisfied with this decision, you or your provider can appeal the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) 2023 Medicare Advantage Plan Benefits explained in plain text. Your provider is aware of how to submit this request. After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. Johns Hopkins Advantage MD P.O. Also, when adding the new generic drug, we may decide to keep the brand name drug on our Drug List, but immediately move it to a different cost-sharing tier or add new restrictions. Spanish. Look on the Extra Help letters you get, or contact the plan to find out your exact costs. Not all plans offer all of these benefits. offers the following coverage and cost-sharing. Call 1-877-354-4611 TTY 711, $10.35 copay or 5% (whichever costs more), $0 copay (limits may apply) (authorization required) (referral not required), $0 copay (authorization required) (referral not required), $0 copay (authorization not required) (referral required), $0 copay (authorization not required) (referral not required), $0 copay (limits may apply) (authorization not required) (referral not required), Covered (authorization not required) (referral not required). You have secure access to all of your personal prescription benefit information so you can easily manage your health online where and when you need to. Spanish. PPO members: 877-293-5325 (TTY: 711) HMO members: 877-293-4998 (TTY: 711) For more information, refer to Chapter 2 in your Evidence of Coverage. This page was last updated: October 28, 2022 at 12:36 pm EST. 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. Privacy Practices Terms & Conditions Accessibility Interoperability Medicare.gov, Notice of Nondiscrimination: If it is listed as a Preferred Product, it does not require step therapy. Once we receive your BAE, we will ask CMS to update your LIS status in its systems. Milton S. Eisenhower Library. Important Message About What You Pay for Insulin You wont pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier its on. This is a 3-star Medicare Advantage plan with Part D (prescription drug) coverage. If you receive extra help, download and refer to the LIS Premium Summary Chart to show you what youll pay each month depending on the plan you have and the level of extra help you get: Johns Hopkins Advantage MD relies on the Centers for Medicare & Medicaid Services (CMS) to determine plan member eligibility for extra help/Low Income Subsidy (LIS). Your prescription must be filled at a network pharmacy, and your cost is determined by your plans tier cost sharing amount (copay or coinsurance). Contact a plan for a Summary of Benefits. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. Advantage MD serves Anne Arundel, Baltimore, Carroll, Frederick, Howard, Montgomery, Somerset, Washington . is offered in the following locations. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. What to Consider When Shopping for Medicare, Johns Hopkins Advantage MD H1225-001 (HMO), $325 per day for days 1 through 5 / $0 per day for days 6 through 90, $0 per day for days 1 through 20 / $160 per day for days 21 through 100, Best Continuing Care Retirement Community (CCRC), Best Medicare Advantage Plan Companies 2023, Medicare Advantage Plus Prescription Drug Plans in Maryland, Medicare Advantage Plus Prescription Drug Plans in 20701 (Anne Arundel County), Johns Hopkins Advantage MD Medicare Advantage Plus Prescription Drug Plans in Maryland, Find Continuing Care Retirement Communites, California Do Not Sell My Personal Information Request. Whole Health Assessment (Online Form) PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. For over 125 years, Marylanders have counted on Johns Hopkins for health care. Medical injectable drugs are medications that you do not self-administer. However, if the U.S. Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or if the drugs manufacturer removes a drug from the market, we will immediately remove the drug from the formulary and notify all affected members as soon as possible. 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. These drugs are covered by Advantage MD under the medical benefit (Part B). This effort requires us to ensure that our members receive only treatment that is medically necessary, according to current standards of practice. These are drugs that usually are injected or infused while you are getting services from a physician, hospital outpatient facility, or ambulatory surgical center. Advantage MD products are offered by Hopkins Health Advantage, Inc., a Maryland health insurer. Please check the plans formulary for specific drugs covered. If you would like a pharmacy directory mailed to you, please call us. Every plan can name their tiers differently, and can place medications on any tier. We do not give, share, sell, or transfer any personal information to a third party unless required bylaw. Any information we provide is limited to those plans we do feature. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare . Personally Provided Information Enrolling is quick and easy. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. You should share a copy of the decision with your doctor so you and your doctor can discuss next steps. Yes No. 2023 Part D Coverage Determinations and Appeals, 2022 Part D Coverage Determinations and Appeals, 2023 Medication Therapy Management Program, 2022 Medication Therapy Management Program, I would like a representative to call me to speak about questions regarding enrolling inaplan, Plan Specific Prescription Drug Coverage Resources, Medications requiring prior authorization, Errata (List of Changes to PPO Formulary), PPO, PPO Plus, PPO Premier Formulary Search Tool, Errata (List of Changes to HMO Formulary), Errata (List of Changes to HMO D-SNP Formulary), Advantage MD Part B Prior Authorization List, PPO, PPO Plus, PPO Premier Comprehensive Formulary (effective 1/1/23) , HMO D-SNP Comprehensive Formulary (effective 1/1/23) , PPO, PPO Plus, PPO Premier Comprehensive Formulary . If you receive a transition supply from a pharmacy, you will receive a letter from us notifying you that you have received a temporary supply of your prescription drug. The Johns Hopkins Advantage MD Plus (PPO)'s formulary is divided into 5 tiers. If you believe that you are not paying the correct monthly premium or costs for your drugs and are eligible for extra help/LIS, you can submit the Best Available Evidence (BAE) to Advantage MD. Johns Hopkins HealthCare has entered the Medicare Advantage market with two plans, Johns Hopkins Medicare Advantage MD and Medicare Advantage MD Plus. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) How this plan performs in coverage of conditions, screenings, customer service and more. Call Member Services for more information. We do not directly sell health insurance or offer professional legal, medical, or financial advice. Contact a plan for a Summary of Benefits. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Note: This is not a complete list of all formulary alternatives covered by your Part D plan. Low income subsidy (LIS), also known as Extra Help, is a program that helps individuals who have a limited income pay for their Medicare prescription drug costs. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Thisgivesyou time to talk to your doctor about pursuing other options available to you within our formulary. Enrollment in plans depends on contract renewal. The Johns Hopkins Advantage MD comprehensive formulary is a complete list of Medicare-approved, prescription brand-name and generic medications we cover. Due to the recent passage of the federal stimulus act, Medicare Sequestration (the two percent cut to payments for Medicare fee-for-service claims, enacted in 2013) will be temporarily lifted beginning on May 1, 2020 and ending on December 31, 2020. Evidence at point-of-sale of recent Medicaid billing and payment in the pharmacys patient profile, backed up by one of the above indicators post point-of-sale. A copy of a state document that confirms your active Medicaid status. Important Message About What You Pay for Insulin You wont pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier its on. TTY . Benefits may vary by carrier and location. Find 1 listings related to Johns Hopkins in Downingtown on YP.com. Medicare has neither approved nor endorsed any information on this site. Get help from a licensed Medicare agent. From April 1September 30, you will need to leave a message on weekends and holidays. Johns Hopkins Advantage MD PO Box 3537 Scranton, PA 18505 Present this card at the time of service and with every prescription. We may remove drugs from the formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. Diabetes testing supplies are covered under Medicare Part B. A screen print from the States Medicaid systems showing your Medicaid status. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . Your prescription must be filled at a network pharmacy, and your cost is determined by your plans appropriate tier copay. We only use data released publicly each year. Limitations and exclusions may apply. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Please refer to your EOC for more detailed information on Johns Hopkins Advantage MD Medicare Transition Process. Contact JHHC. Ready to sign up for Johns Hopkins Advantage MD D-SNP (HMO D-SNP) Brody Learning Commons. Medicare Coverage. You will receive notice when necessary. Certain medical injectable drugs also require prior authorization or step therapy. If you have questions about BAE or need help getting documented proof, please call Member Services. All plan-related information on this site is from www.cms.gov and www.medicare.gov. Johns Hopkins Advantage MD. You may not get this notice before we make the change. Johns Hopkins Advantage MD offers preferred provider organization (PPO) plans and health maintenance organization (HMO) plans with Medicare Part D prescription drug coverage for Medicare-eligible residents in Maryland. Offered throughout most of Maryland, a Johns Hopkins Medicare Advantage plan provides you with comprehensive Medicare coverage including Medicare Part D drug coverage. If your drug is not listed, it does not require prior authorization. Important Message About What You Pay for Vaccines Our plan covers most Part D vaccines at no cost to you. The directions on how to file an appeal are in your notification letter or in Chapter 9 of your Evidence of Coverage. Johns Hopkins Advantage MD is available to residents of these counties: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); I would like a representative to call me to speak about questions regarding enrolling in a plan. You may obtain a print version of your formulary by calling us. How this plan performs in coverage of conditions, screenings, customer service and more. Box 3537 Scranton, PA 18505. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Your prescription must be filled at a network pharmacy, and your cost is determined by your plans tier cost sharing amount (copay or coinsurance). The cost-sharing for this plan is divided as follows: Tier 1 ( Preferred Generic) contains 444 drugs and has a co-payment of $4.00. If you need help finding an HMO network pharmacy, please call us toll-free at 877-293-4998 (TTY:711). If you get extra help from Medicare to pay for your prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. This gives you time to talk to your doctor about pursuing other options available to you within our formulary. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Review your prescription savings guide for savings opportunities, Track and print your prescription drug spending, Order your long-term medications through mail service, View your mail service prescription order status. $10.35 copay or 5% (whichever costs more), Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). After reviewing your ANOC, if you notice that a covered prescription drug you currently take will either not be covered in the future years formulary or its cost sharing or coverage has changed for the current plan year, you should discuss your situation with your doctor to either find an appropriate alternative prescription drug that is covered by the formulary, or request an authorization or exception before the new plan year begins. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . Your provider is responsible for submitting the prior authorization or step therapy exception request. P.O. See the Part D Premium Reduction section below for more details. Acceptable forms of Best Available Evidence include: You must mail one of the accepted forms of BAE to: Johns Hopkins Advantage MD This field is for validation purposes and should be left unchanged. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). H1225 003 0 available in Anne Arundel, Howard and Montgomery Counties. Johns Hopkins Advantage MD (HMO) Quick Reference Guide To obtain the most up-to-date information on policies, manuals, directories and other Staying Healthy: Screenings, Tests and Vaccines, Members Whose Plan Did an Assessment of Their Health Needs and Risks, Yearly Review of All Medications and Supplements Being Taken, Yearly Pain Screening or Pain Management Plan, Osteoporosis Management in Women Who Had a Fracture, Eye Exam to Check for Damage from Diabetes, Kidney Function Testing for Members with Diabetes, Plan Members with Diabetes Whose Blood Sugar Is under Control, The Plan Makes Sure Member Medication Records Are Up-to-Date after Hospital Discharge, The Plan Makes Sure Members with Heart Disease Get the Most Effective Drugs to Treat High Cholesterol, Ease of Getting Needed Care and Seeing Specialists, Health Plan Provides Information or Help when Members Need It, Coordination of Members' Health Care Services, Member Complaints and Changes in the Health Plan's Performance, Complaints about the Health Plan (More Stars Are Better because It Means Fewer Complaints), Members Choosing to Leave the Plan (More Stars Are Better because It Means Fewer Members Choose to Leave the Plan), Improvement (if Any) in the Health Plan's Performance, Health Plan Makes Timely Decisions about Appeals, Fairness of the Health Plan's Appeal Decisions, Based on an Independent Reviewer, Availability of TTY Services and Foreign Language Interpretation when Prospective Members Call the Health Plan, Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). | about | johns hopkins medicare advantage | legal and privacy, Johns Hopkins Medicine < /a > you are as! 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