This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) You may obtain a print version of your formulary by calling us. Monthly Drug Premium *Included in Monthly Plan Premium. 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). Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Whole Health Assessment Form. Call Member Services for more information. 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. Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Enrollment in plans depends on contract renewal. Your prescription must be filled at a network pharmacy, and your cost is determined by your plans tier cost sharing amount (copay or coinsurance). We do not offer every plan available in your area. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, Inc If you are taking the brand name drug at the time we make the change, we will provide you with information about the specific change(s) we made. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) Yes No. 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. Enroll on the phone or online! For USFHP paper claims, mail to: Johns Hopkins HealthCare PO Box 830479 Birmingham, AL 35283 Attn: USFHP Claims Submission. Please be advised that Johns Hopkins Medicine hospitals and most Johns Hopkins University physicians participate with Medicare, but we are not contracted with most Medicare Advantage Plans. Benefits may vary by carrier and location. We only use data released publicly each year. 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. This change applies to all Maryland Johns Hopkins Advantage MD plans. Search for policies. 8 a.m.-8 p.m., 7 days a week. We do not feature every plan available in your area. You are about to leave the Johns Hopkins Advantage MD website. Spanish. The list of changes that have been made to the formulary is called the errata. A copy of your Medicaid card, which includes your name and the eligibility date. The Johns Hopkins Advantage MD Plus (PPO)'s formulary is divided into 5 tiers. See reviews, photos, directions, phone numbers and more for Johns Hopkins locations in Downingtown, PA. . Current Members: . 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. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. Online Research Consultation. Advantage MD products are offered by Hopkins Health Advantage, Inc., a Maryland health insurer. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. Prospective Members: 1-888-403-7682. After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs. 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. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . Look on the Extra Help letters you get, or contact the plan to find out your exact costs. Members will learn what heart disease is and how to manage their risk factors through stress reduction, exercise, healthy eating, medication management, and regular visits with their healthcare team. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). Ready to sign up for Johns Hopkins Advantage MD D-SNP (HMO D-SNP) Your provider requests this approval and exception it is their responsibility. Not all plans offer all of these benefits. Medical Clinics Physicians & Surgeons (215) 829-6607. is offered in the following locations. Llame al 877-293-5325 (TTY: 711) Chinese: 877-293-5325 (TTY: 711). Contact a plan for a Summary of Benefits. offers the following coverage and cost-sharing. You are about to leave the Johns Hopkins Advantage MD website. Every year, Medicare evaluates plans based on a 5-star rating system. Approximately 900,000 Marylanders are eligible for Medicare, but only 11 percent are enrolled in Medicare Advantage, compared with 34 percent nationwide. Find 1 listings related to John Hopkins Community Physicians in Downingtown on YP.com. Offered throughout most of Maryland, a Johns Hopkins Medicare Advantage plan provides you with comprehensive Medicare coverage including Medicare Part D drug coverage. Medicare Coverage. Privacy Practices Terms & Conditions Accessibility Interoperability Medicare.gov, Notice of Nondiscrimination: Excited about the expansion of Johns Hopkins Advantage MD Medicare Advantage products in 2023. 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. is a Medicare Advantage (Part C) Special Needs Plan by Johns Hopkins Advantage MD. 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). We are available for assistance 24 hours a day, seven days a week. Box 3538. 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. Limitations and exclusions may apply. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. This is a 3-star Medicare Advantage plan without Part D (prescription drug) coverage. Not affiliated with or endorsed by any government agency. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) 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. Please check the plans formulary for specific drugs covered. Not all plans offer all of these benefits. 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. ? Once you reach that amount, you will enter the next coverage phase. Once we receive your BAE, we will ask CMS to update your LIS status in its systems. Some medications covered by Johns Hopkins Advantage MD require prior authorization (or pre-authorization) and/or step therapy. This page was last updated: October 28, 2022 at 12:36 pm EST. Any information we provide is limited to those plans we do offer in your area. You are about to leave the Johns Hopkins Advantage MD website. Plan Benefits. Contact JHHC. If you are affected by formulary changes from one contract year to the next, you may be eligible to receive a temporary 30-day supply of your prescription drug within the first 90 days of the new plan year while you work with your doctor to either obtain a covered alternative prescription drug or request a formulary exception. Search for a Provider. Medicare has neither approved nor endorsed any information on this site. If you need help finding an HMO network pharmacy, please call us toll-free at 877-293-4998 (TTY:711). All insurance agents and enrollment platforms linked to this site have their own terms and conditions. English | Would you like to continue? From April 1September 30, you will need to leave a message on weekends and holidays. 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. For other changes to drugs on the Drug List, if the change affects a drug you take, we will notify you in writing at least 30 days before the change is effective or we will give you a 30-day refill on the drug you are taking at a network pharmacy. 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. Baltimore - December 8, 2016. Advantage MD verifies the medical necessity of the medication using independent, objective medical criteria. 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). This effort requires us to ensure that our members receive only treatment that is medically necessary, according to current standards of practice. If your request is approved, we will authorize coverage before the new plan year. As a renewing or continuing member, you will receive your Annual Notice of Change (ANOC) by September 30. Posted 4:23:59 PM. These are drugs that usually are injected or infused while you are getting services from a physician, hospital outpatient facility, or ambulatory surgical center. This gives you time to talk to your doctor about pursuing other options available to you within our formulary. A copy of a letter from the state or the Social Security Administration (SSA) showing your Medicare LIS status. We know prescription drug coverage is very important to you. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. Tier 2 ( Generic) contains 1,533 drugs and has a . Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. Details drug coverage for Johns Hopkins Advantage MD Johns Hopkins Advantage MD (HMO) in Maryland. All preferred and non-preferred Part B drugs are identified on the Advantage MD Part B Prior Authorization List. 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. 2023 Medicare Advantage Plan Benefits explained in plain text. How this plan performs in coverage of conditions, screenings, customer service and more. O'Brien Johns. Prospective Members: 1-888-403-7682. This field is for validation purposes and should be left unchanged. P.O. Medicare - Health Care Reimbursement - Guides at Johns Hopkins University. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. Waiver of Liability Statement. Important Message About What You Pay for Vaccines Our plan covers most Part D vaccines at no cost to you. See the Part D Premium Reduction section below for more details. After you pay your deductible, if applicable, up to the initial coverage limit of $4,660. Please note: the information in this section does not apply to AdvantageMD Group. The Johns Hopkins Advantage MD comprehensive formulary is a complete list of Medicare-approved, prescription brand-name and generic medications we cover. Once Advantage MD reviews the request, you will be notified of the decision via phone and mail. Find 1 listings related to Johns Hopkins in Downingtown on YP.com. You are about to leave the Johns Hopkins Advantage MD website. P.O. Please contactwww.medicare.govor1-800-MEDICARE(TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information about Medicare plan options. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. Johns Hopkins Advantage MD P.O. IMPORTANT: This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP). Acceptable forms of Best Available Evidence include: You must mail one of the accepted forms of BAE to: Johns Hopkins Advantage MD Look up plan benefits. DO NOT BILL MEDICARE Medicare limiting charges apply. 10am - 6pm. Every plan can name their tiers differently, and can place medications on any tier. Diabetes testing supplies are covered under Medicare Part B. For prescription drug on formulary at in-network pharmacy. So wherever life takes you, we're here to help. 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. A thirty (30) day supply is the maximum transition amount, and could be less if your prescription is written for fewer days. Johns Hopkins Advantage MD. 1700 Spruce St. Philadelphia, PA 19103. Plain text explanation available for any plan in any state. 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. Who you are:As a Medicare Marketing Specialist for Johns Hopkins HealthCare, you are an experiencedSee this and similar jobs on LinkedIn. If you are outside of the transition period and are experiencing circumstances that involve a level of care change (moving from home to a long-term care facility, or from a long-term care facility to home), the pharmacist who refills your prescription will be able to provide you up to a 31-day supply (unless you have a prescription written for fewer days) of your medications. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . How this plan performs for drug pricing, patient safety, member experience and more. If you have questions about BAE or need help getting documented proof, please call Member Services. 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. 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