Please consider prescribing generic blood pressure, cholesterol, and diabetes medications as 100-day supplies to help your patients save money and improve their adherence. 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. *Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. 77 0 obj <>/Filter/FlateDecode/ID[<0ABEC5C4C8EF4BE4B3D202653CDF91C4><4A630CA9FB2EAC409BE2A68EF5C7D8C0>]/Index[50 49]/Info 49 0 R/Length 125/Prev 193716/Root 51 0 R/Size 99/Type/XRef/W[1 3 1]>>stream Use the chart below to see your benefits at-a-glance. %%EOF Search health topics in theHealth Library. 39 0 obj <> endobj You must have both Part A. 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. 0000031441 00000 n Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. 0000034857 00000 n LA - Limited Access, available only at certain pharmacies per manufacturers restriction. Get the Facts on Medicare . Limitations:1. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . 0000012661 00000 n xref Examples of OTC items include, but are not limited to: Members can select and order OTC products from the Advantage MD OTC Catalog. Members are responsible for the difference between the allowed amount and the billed amount. $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. CVS/caremark mail order pharmacy provides mail order requests to members. We are vaccinating all eligible patients. 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. Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. 0000002419 00000 n 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. 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. About Johns Hopkins Medicine. 0000789385 00000 n Don't forget that new CMS regulations require disclosures . Overall Government Star Rating 3.5. out . Personally Provided Information Advantage MD requires prior authorizationand/or step therapy for certain provider-administered medications to determine medical necessity. Please refer to the pharmacy prescription benefit section of the Provider Manual or the plan's member website vaccine coverage page. The plans website includes apharmacy locator for members and providers to easily locate participating pharmacies. $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); $0 copay (dental x-ray). 98 0 obj <>stream The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Excited about the expansion of Johns Hopkins Advantage MD Medicare Advantage products in 2023. Browse provider manuals. Part A and Part B are also known as "Original Medicare". It is the ordering providers responsibility to determine which specific codes require prior authorization or have step therapy. 0000025072 00000 n If you prefer to work out at home in lieu of a participating fitness center, you have the option to enroll in the Silver&Fit Home Fitness Program and receive up to two home fitness kits each benefit year at no charge. Call 1-877-354-4611 TTY 711. Our formularies are updated on a monthly basis or whenever formulary changes occur. &/I&09LHH"8Hi{Xf$ @ yBF0 Hy Johns Hopkins Advantage MD offers low premiums, member cost sharing, and . Information may need to be submitted describing the use and setting of the drug to make the determination. Certain products are identified in the catalog as Dual-Purpose. With useful Medicare information delivered right to your inbox. 0000021832 00000 n Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Contact customer service at 1-855-662-3017. Search for policies. Quantity Exceptions can be requested when a medical condition warrants use of quantities greater than listed quantities for each drug. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. PPO Step Therapy CriteriaHMO Step Therapy CriteriaD-SNP (HMO) Step Therapy Criteria. Notice of Privacy Practices(Patients & Health Plan Members). Limitations:1. For non-Medicare covered dental related inquiries, please contact DentaQuest: 1-844-231-8318 Authorization: 1-877-293-5325 Masks are required inside all of our care facilities. Johns Hopkins Advantage MD covers both Medicare Part B and Part D medications. 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. If the drug is not listed, it does not require prior authorization. Get help from a licensed Medicare agent. 0000012697 00000 n 0000028930 00000 n %PDF-1.7 % 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. PPO Prior Authorization CriteriaHMO Prior Authorization CriteriaD-SNP (HMO) Prior Authorization Criteria. 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. Use this search tool to find doctors, hospitals, prescription drugs, and pharmacies within the Advantage MD network. Johns Hopkins Advantage MD Primary (PPO) Medicare Plan Details (2023 Plan) Monthly Premium (select county for price) by Johns Hopkins Advantage MD Additional Coverage Hearing Vision Dental Overall Government Star Rating 3.0 out of 5 stars Plan Type Medicare Advantage (Part C) with Prescription Drug (Part D) Medicare Part A is a health insurance program administered by the federal government which primarily covers inpatient hospital care, but also covers skilled nursing facility, hospice care, and home health care costs. Certain medications are required to satisfy specific step therapy criteria. Advantage MD is a health insurance plan that provides Medicare benefits through the nonprofit corporation Johns Hopkins Healthcare LLC. 0000035255 00000 n Those having their benefits terminated will lose access to reduced prices for prescriptions, better copays, and access to vision and dental benefits. Additional Coverage. 97 0 obj <> endobj Only non-Low Income Subsidy (LIS) enrollees are eligible for the reduced cost-sharing. Coverage of these drugs are subject to specific criteria approved by Medicare. 0000085838 00000 n 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. *Please note: this information does not apply to AdvantageMDGroup. 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. Not all plans offer all of these benefits. 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. Opioid/Benzodiazepine Drug Interaction Edit. The search results and formulary drug list will indicate if any prior authorizations, quantity limits, or step therapy requirements apply. From April 1September 30, you will need to leave a message on weekends and holidays. To find a participating fitness center, you can search for the closest Silver&Fit fitness centers to you on the Silver&Fit website at. Medicare plans are available to all Medicare beneficiaries. 0000012071 00000 n Gap Coverage Phase. 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. If a request is denied, an appeal or a redetermination may be filed within 60 calendar days from the date of the first decision. 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. For a complete comparison of which medications are covered by which part, please refer to the Medicare Part B vs. Part D chart. By signing the Agreement for Care Form, you agree that your Johns Hopkins Medicine health care provider can be paid directly by your insurance. It will cost $301 per month in 2022. Tier 5 (Specialty Tier) medications are exempt from tier exception.
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