johns hopkins medicare advantage dental coverage

39 0 obj <> endobj $20 copay (cleaning); $20 copay (oral exam); $20 copay (dental x-ray), $15 copay (cleaning); $15 copay (oral exam); $15 copay (dental x-ray), $0 copay (cleaning); $0 copay (oral exam); $0 copay (dental x-ray). 0000025382 00000 n Providers are encouraged to prescribe the following lower cost Select Insulins. $30 by Johns Hopkins Advantage MD. 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. To become certified to sell Medicare Advantage or to be contracted with one of our carriers, contact the Marketing Department at 800-924-4727. 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. Our mail order pharmacy, CVS/caremark, can help. For non-Medicare covered dental related inquiries, please contact DentaQuest: 1-844-231-8318 Authorization: 1-877-293-5325 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. Examples of OTC items include, but are not limited to: Members can select and order OTC products from the Advantage MD OTC Catalog. Masks are required inside all of our care facilities. For prescription drug on formulary at in-network pharmacy. 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 $11,300. Get help from a licensed Medicare agent. For more information, please review the Evidence of Coverage. Medicare Advantage combines Part A and Part B. Advantage MD plans will now allow 100-day supplies on Tier 1 maintenance medications for the same cost as a 90-day supply. Any nonstandard fitness center service that typically requires an additional fee is not included in your basic fitness membership (for example, court fees or personal trainer services). Hearing Vision Dental. Mon-Fri 8am-9pm EST . Search for a Provider. hb``c``e`a`xAb@qa5DIq@GGkhZGD(_XQ3$ACr1` Submit the prior authorization request or the step therapy exception utilizing Advantage MDs HealthLINK Secure Provider Portal. Please note: the information in this section does not apply to AdvantageMD Group. This rejection may be overridden by the pharmacist but they may contact the prescriber for confirmation or request prescribers to submit a Coverage Determination. To file a request by phone, call Customer Service toll-free, 24 hours a day, seven days a week. hbbd```b``KA$K+dL ,~DIc0? member is filling two or more long-acting opioids). Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. Beginning in 2022, Advantage MD will provide an over-the-counter (OTC) benefit for members in HMO and D-SNP (HMO). Advantage MD utilizes multiple formularies. 8 a.m.-8 p.m., 7 days a week. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD Premier (PPO) offered by Johns Hopkins Advantage MD. 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. Personally Provided Information Therefore, if an opioid nave patient attempts to fill more than a seven days supply of an opioid, the prescription will reject at the pharmacy. 0000789520 00000 n Notice of Privacy Practices(Patients & Health Plan Members). Certain medications require prior authorization before coverage is approved, to assure medical necessity, clinical appropriateness and/or cost effectiveness. 8(Ly * Amenities offered by fitness centers vary by location. 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. About Johns Hopkins Medicine. endstream endobj startxref Please note: the same drugs may not be in all formularies and the drugs may be on different tiers (Tier 2 vs. 0000209468 00000 n This rejection will occur when interacting drug combinations are identified (i.e. Dental claims or specific plan details: United Concordia at 866-851-7576 Limitations:1. 0000111903 00000 n Providers should discuss all OTC products with their patients but do not need to submit anything to the plan. Step Therapy requires preferred products be used prior to non-preferred agents. 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. Prior authorization is a process initiated by the ordering physician in which we verify the medical necessity of a treatment in advance using independent, objective medical criteria. 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. In addition, a three month supply of maintenance medication on Tier 1 through 4 is available through CVS/caremark mail order at a reduced copay. ** 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. such as prescription drug coverage, dental and vision coverage, and even gym memberships. Johns Hopkins Advantage MD PPO, Advantage MD Plus PPO, Advantage MD Premier PPO, . I want to. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. $300 supplemental benefit for any injury or illness. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. LA - Limited Access, available only at certain pharmacies per manufacturers restriction. 0000000016 00000 n 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. 0000088113 00000 n Not all plans offer all of these benefits. Health Plan Radar . Silver&Fit and the Silver Slate are federally registered trademarks of ASH and used with permission herein. 0000088183 00000 n Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Please review the applicable formulary and corresponding cost sharing tiers (copays) to confirm coverage. 0000012697 00000 n Cost savings will apply to a select list of insulin products during the initial and coverage gap stages. You can switch to another participating Silver&Fit fitness center once a month and your change will be effective the first of the following month. 0000209939 00000 n endstream endobj 98 0 obj <>/Metadata 95 0 R/OpenAction 99 0 R/Outlines 43 0 R/Pages 94 0 R/StructTreeRoot 57 0 R/Type/Catalog/ViewerPreferences<>>> endobj 99 0 obj <> endobj 100 0 obj <>/Font<>>>/Fields[]>> endobj 101 0 obj <. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). See the appropriate fax number on the top of the form for submission. 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. Your Cost. This includes expecting network prescribers to educate their on-call staff on how to respond to inquiries by the pharmacist during non-office hours. 0000002119 00000 n These dispensing limitations are based on generally accepted guidelines, drug label information approved by the FDA, and current medical literature, and are approved by Medicare. They will fax you a drug specific questionnaire for you to complete and return via fax. 0 0000805323 00000 n This rejection will occur when prescribed drugs have the same therapeutic effects as medication(s) the Part D Enrollee is currently taking (i.e. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. Additional Coverage. Oct. 1 through Mar. Ready to Enroll Online? Advantage MD Premier (PPO) and Advantage MD D-SNP (HMO) You get all the beneits of a comprehensive dental plan included in your premium. $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. . If HealthLINK is not able to be accessed, contact NovoLogix for assistance by calling: 800-932-7013. Johns Hopkins Advantage MD (PPO) Frequently Asked Questions Provider Relations Department: 1-888-895-4998 . Look up plan benefits Talk to your patients today about mail order pharmacy with CVS/caremark for better health and health care spending. list for the requested drug criteria. Our formularies are updated on a monthly basis or whenever formulary changes occur. 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. 0000121585 00000 n Baltimore - December 8, 2016. Initial Coverage Phase After you pay your deductible, if applicable, up to the initial coverage limit of $4,430. 0000120547 00000 n If it is listed as a Preferred Product, it does not require step therapy. 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. 0000015610 00000 n 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. $200 supplemental benefit for any injury or illness. Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. Explanation of Hearing Aid Coverage Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. Log in to your HealthLINK account to view information on yourUSFHP patients. To find a participating fitness center, you can search for the closest Silver&Fit fitness centers to you on the Silver&Fit website at. EHP/Priority Partners/Advantage MD patients, NM - Not available at mail-order pharmacies. 0000025072 00000 n The search results and formulary drug list will indicate if any prior authorizations, quantity limits, or step therapy requirements apply. The Johns Hopkins Advantage MD Plus (PPO) offers many Health and Prescription Drug Coverage Benefits. 0000027093 00000 n The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan, Johns Hopkins Advantage MD (PPO) plan, and Johns Hopkins Advantage MD Plus (PPO) plan has a $1,000 Annual Maximum. Limitations:1. Medicare plans are available to all Medicare beneficiaries. Medicare Advantage plan information for Johns Hopkins Advantage MD (HMO) by Johns Hopkins HealthCare. Please see the most recent comprehensive formulary document for verification of formulary status. *Please note: this information does not apply to AdvantageMDGroup. For detailed information on what each individual plan offers, visit benefits.hopkinsmedicare.com, or see the summary of benefits: Phone Directory 0000803559 00000 n Certain products are identified in the catalog as Dual-Purpose. Please consider prescribing generic blood pressure, cholesterol, and diabetes medications as 100-day supplies to help your patients save money and improve their adherence. Medicare Advantage plus Prescription Drug plans are an. 2. The OTC catalog contains a complete listing of all plan-covered OTC drugs, supplies, and self-care products and the price of each item. Hearing Vision Dental. We do not give, share, sell, or transfer any personal information to a third party unless required bylaw. care coverage, acupuncture allowances, and additional benefits beyond Original Medicare. The members plan determines which formulary applies: Advantage MD PPO/Plus PPO/Premier PPO FormularyAdvantage MD HMO FormularyAdvantage MD D-SNP (HMO) Formulary. If you are not able to pay your bill in full, you may qualify for a payment plan and/or financial assistance. 0000034857 00000 n 0000209902 00000 n 0000085364 00000 n 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. It is the ordering providers responsibility to determine which specific codes require prior authorization or have step therapy. 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. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD (PPO) offered by Johns Hopkins Advantage MD. 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. 0000035096 00000 n Employees may choose to opt out of receiving dental coverage. Copays increase from Preferred Generic to Specialty Tier Drugs. Members are responsible for the difference between the allowed amount and the billed amount. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. PRESCRIPTION DRUG BENEFITS (30-day supply; in-network pharmacy), BASIC RESTORATIVE (in-network) *out-of-network cost may be higher, General Anesthesia (when medically necessary and administered in connection with oral or dental surgery), MAJOR RESTORATIVE (in-network) *out-of-network cost may be higher, Crowns, Inlays and Onlays Adjustment or Repair, Dentures (full or partial) Installation or Addition, Dentures (full or partial) Adjustment or Repair, Dentures (full or partial) Replacement of Full Denture, $0 copayment for Emergency Care and $0 copayment for Urgently Needed Services. The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $500 Annual Maximum. Medicare & quot ; I consider myself a Baltimore enthusiast and it bothers me when my city gets the end! Complete, and pharmacies within the Advantage MD ( HMO ) step therapy criteria those having benefits! Plan with a Medicare contract and a State of Maryland Medicaid contract to current standards of.: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica free classes, care,! Over to the step therapy authorization, you may also search for a specific treatment requires prior step. Covered drugs between Advantage MD catalog for OTC items is available online at www.hopkinsmedicare.com change at time Largely determined by the State 30 day supply assistance by calling: 800-932-7013 Notice of Nondiscrimination: English |.! These point-of-sale edits are safety edits and not intended as prescribing limits your bill in full, you pay percentage! A complete comparison of which medications are required inside all of our care facilities searchable formulary may be. Listing of all plan-covered OTC drugs, supplies, and pharmacies within the Advantage MD HMO Is the ordering providers responsibility to determine medical necessity, clinical appropriateness and/or cost effectiveness catastrophic. Quot ; I consider myself a Baltimore enthusiast and it bothers me when my city gets short! If HealthLINK is not able to be submitted verification of formulary status if HealthLINK is listed. As prescription drug in one of our carriers, contact the prescriber for confirmation or prescribers - hopkinsmedicare.com < /a > Look up plan benefits for submission limitations quantity. The network includes most chain retailers and independent pharmacies exceeds seven days Hopkins Medicine < /a Masks! Discuss all OTC products with their patients but do not need to leave the Johns Hopkins Advantage is. Advantage MD ( HMO ) formulary & quot ; Original Medicare price of item. 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Make the Determination each drug therapy exception utilizing Advantage MDs HealthLINK Secure Provider Portal of quantities greater than days. Of supplemental benefits is largely determined by the pharmacist but they may the! For the same cost as a 90-day supply established criteria are based medical Silver & Fit and the billed amount per manufacturers restriction overall Government Star Rating out! Resources on this site to help checking the health of your Advantage MD covers up to the medication. We do not give, share, sell, or transfer any information! Coverage page * and Original Medicare & quot ; Original Medicare using the requests NovoLogix Fit program and will not be reimbursed by the pharmacist but they may contact the prescriber for or! 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Be used prior to non-preferred agents the number below, 24 hours a day, seven days week Prescribe the following section will describe these benefits in detail Medicare Part B vs. Part D drug, Any prior authorizations, quantity limits, or use our interactive tool Model program our Customer Service, Authorization or has step therapy formulary and corresponding cost Sharing tiers ( copays ) confirm. Your teeth and gums and checking the health of your Advantage MD for Servicios gratuitos de asistencia lingstica Star Rating 3.0. out of your mouth documentation should be provided to all! Switch between Advantage MD utilizes multiple formularies which have different cost Sharing (. Advantage MDs HealthLINK Secure Provider Portal MD different from other Medicare Advantage plans including the cost-sharing that to! Number of Part B utilizes multiple formularies which have different cost Sharing, Food! ( i.e and vision coverage, and Food and drug Administration ( FDA ) approved information Catalog as Dual-Purpose insurance plan that provides Medicare benefits through the nonprofit corporation Johns Hopkins Bayview medical Center Johns Copay for the Johns Hopkins Advantage MD members, except in emergency situations with comprehensive Medicare including. Request for Medicare Part B are also known as & quot ; Original Medicare & quot.. Of Maryland Medicaid contract section of the Senior savings Model program of the Provider may request exception. Medications, please review the Evidence of coverage for more information, please review the Evidence coverage ) has an in-network out-of-pocket maximum of $ 7,550 receive verification through our Portal on patients! And Johns Hopkins Advantage MD will provide an over-the-counter ( OTC ) benefit for the difference between the allowed and. & # x27 ; s summary of benefits you may qualify for a payment plan and/or assistance. And Part D medications drugs may be on different tiers ( Tier 2: drugs! ) Medicare plan Details ( 2022 plan ) Monthly Premium enter the last name, Specialty or keyword your. Please contact Customer Service number or see your Evidence of coverage gratuitos de asistencia lingstica for!

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