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. Once you reach that amount, you will enter the next coverage phase. Current Members: . 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. Availability of TTY Services and Foreign Language Interpretation when Prospective Members Call the Drug Plan, Member Complaints and Changes in the Drug Plan's Performance, Complaints about the Drug Plan (More Stars Are Better because It Means Fewer Complaints), Improvement (if Any) in the Drug Plan's Performance, Ease of Getting Prescriptions Filled when Using the Plan, Plan Provides Accurate Drug Pricing Information for Medicare's Plan Finder Website, Taking Blood Pressure Medication as Directed, Taking Cholesterol Medication as Directed, Members Who Had a Pharmacist (or Other Health Professional) Help Them Understand and Manage Their Medications, The Plan Makes Sure Members with Diabetes Take the Most Effective Drugs to Treat High Cholesterol. What to Consider When Shopping for Medicare, Johns Hopkins Advantage MD Tribute H1225-004 (HMO), $350 per day for days 1 through 5 / $0 per day for days 6 through 90, $0 per day for days 1 through 20 / $196 per day for days 21 through 100, Best Continuing Care Retirement Community (CCRC), Best Medicare Advantage Plan Companies 2023, Medicare Advantage Plans in 20701 (Anne Arundel County), Johns Hopkins Advantage MD Medicare Advantage Plans in Maryland, Find Continuing Care Retirement Communites, California Do Not Sell My Personal Information Request. This change applies to all Maryland Johns Hopkins Advantage MD plans. Johns Hopkins Advantage MD Medicare Advantage Plans with Part D in The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Personally Provided Information If your drug is not listed, it does not require prior authorization. Johns Hopkins Advantage MD | Maryland Medicare Advantage Plan 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. Whatever Your Needs, Johns Hopkins Has You Covered. 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. Enrollment in plans depends on contract renewal. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare . Johns Hopkins HealthCare has entered the Medicare Advantage market with two plans, Johns Hopkins Medicare Advantage MD and Medicare Advantage MD Plus. 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. Once we receive your BAE, we will ask CMS to update your LIS status in its systems. Scranton, PA 18505. English | Not affiliated with or endorsed by any government agency. 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). Box 3538. Get help from a licensed Medicare agent. This page was last updated: October 14, 2022 at 8:56 pm EST. 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. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. U.S. News does not have a relationship with, or receive remuneration from Johns Hopkins Advantage MD. You are about to leave the Johns Hopkins Advantage MD website. Note: This is not a complete list of all formulary alternatives covered by your Part D plan. 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). Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Once Advantage MD reviews the request, you will be notified of the decision via phone and mail. You may not get this notice before we make the change. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. 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. Chronic Disease Self-Management Archives - Johns Hopkins Advantage MD Whole Health Assessment Form. You may obtain a print version of your formulary by calling us. 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. If you have questions about BAE or need help getting documented proof, please call Member Services. If you need help finding an HMO network pharmacy, please call us toll-free at 877-293-4998 (TTY:711). Johns Hopkins Advantage MD covers both Medicare Part B and Part D medications. Johns Hopkins Advantage MD Plus (PPO) - Q1GROUP LLC Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . P.O. Every plan can name their tiers differently, and can place medications on any tier. Advantage MD is committed to delivering cost-effective quality care to our members. 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. The full BAE policy is available atCMS.gov. 8 a.m.-8 p.m., 7 days a week. Some medications covered by Johns Hopkins Advantage MD require prior authorization (or pre-authorization) and/or step therapy. Our formulary is updated monthly and as formulary changes occur. Yes No. PDF Johns Hopkins Advantage MD (HMO) Quick Reference Guide Salma Riaz, MHA on LinkedIn: Home Your provider is aware of how to submit this request. 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 (HMO D-SNP) 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. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Maryland Medicare Options is Licensed and Certified to sell Johns Hopkins Medicare Advantage Plans. H1225 003 0 available in Anne Arundel, Howard and Montgomery Counties. 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. From April 1September 30, you will need to leave a message on weekends and holidays. Insurance Information | Johns Hopkins Medicine Thats whyJohns Hopkins Advantage MD offers a Part D prescription benefit with our plan options. We are available for assistance 24 hours a day, seven days a week. Always seek the advice of your doctor regarding your prescription medications. Scranton, PA 18505. Johns Hopkins Advantage MD D-SNP (HMO D-SNP) Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. O'Brien Johns. Your provider may request an exception to the step therapy for specific circumstances that warrant a need for a non-preferred product. LifeBridge Health Becomes Part Owner In Johns Hopkins Medicare Contact a plan for a Summary of Benefits. 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 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. Online Research Consultation. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. Medicare - Health Care Reimbursement - Johns Hopkins University I would like a representative to call me to speak about questions regarding enrolling inaplan, Care and Resources for Members with Diabetes, 5 Reasons To Make This Health Plan Part Of Your Retirement, Your Personal Care Plan for All Advantage MD Members, 60-minute heart disease workshop for adults. TTY . Access Provider Resources. This field is for validation purposes and should be left unchanged. This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. AdvantageMD - hopkinsmedicare.com 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. Remember, by switching to an alternative generic or brand-name drug included on our formulary, you can avoid paying the full cost for a non-formulary drug. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. Johns Hopkins is terminating its Advantage MD plans for Medicare-eligible Baltimore City residents, forcing over 5,000 seniors to look elsewhere for reduced prescription drug prices and reasonable . Medical Clinics Physicians & Surgeons (215) 829-6607. Plan Benefits. provides the following cost-sharing on drugs. We are available for assistance 24 hours a day, seven days a week. Prior Authorization means that Advantage MD must first approve the medication before your provider can prescribe or administer it. P.O. Prospective Members: 1-888-403-7682. For USFHP paper claims, mail to: Johns Hopkins HealthCare PO Box 830479 Birmingham, AL 35283 Attn: USFHP Claims Submission. Look up plan benefits. 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. Your provider is responsible for submitting the prior authorization or step therapy exception request. 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. Baltimore - December 8, 2016. Note: The formulary and pharmacy network may change at any time. For questions and help requesting a formulary exception, please call us. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227 . Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. As a renewing or continuing member, you will receive your Annual Notice of Change (ANOC) by September 30. Not all plans offer all of these benefits. Look on the Extra Help letters you get, or contact the plan to find out your exact costs. Important Message About What You Pay for Vaccines Our plan covers most Part D vaccines at no cost to you. 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. We do not offer every plan available in your area. At a Glance. After the total drug costs paid by you and the plan reach $4,660, up to the out-of-pocket threshold of $6,350. Certain medical injectable drugs also require prior authorization or step therapy. 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. A copy of your Medicaid card, which includes your name and the eligibility date. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. Monthly Drug Premium *Included in Monthly Plan Premium. You must have both Part A and . Contact the plan for details. This is a 3-star Medicare Advantage plan without Part D (prescription drug) coverage. We are available 24 hours a day, seven days a week. Register your account at caremark.com for time and savings opportunities, and discover these benefits: If you were taking a non-formulary drug, or a drug with a Step Therapy or Prior Authorization restriction before joining our plan, ourtransition process will allowthe pharmacist who refills your prescription to provide you with a temporary 30-day supply of the drug within the first 90 days of your membership in a Johns Hopkins Advantage MD plan. 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. 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. Johns Hopkins Advantage MD Medicare Advantage Plans with Part D The following Johns Hopkins Advantage MD plans offer Medicare Advantage Prescription Drug plan coverage to Maryland residents. 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. 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. Limitations and exclusions may apply. See reviews, photos, directions, phone numbers and more for John Hopkins Community Physicians locations in Downingtown, PA. Toview the latest changes that have been made to the formulary, you can download and refer to the errata sheet: For questions about drugs covered in the PPO formulary, call us toll-free at 877-293-5325 (TTY: 711) and select option or questions about drugs covered in the HMO and HMO D-SNP formularies, call us toll-free at 877-293-4998 (TTY: 711). Spanish. 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. Your prescription must be filled at a network pharmacy, and your cost is determined by your plans appropriate tier copay. 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. All insurance agents and enrollment platforms linked to this site have their own terms and conditions. A thirty (30) day supply is the maximum transition amount, and could be less if your prescription is written for fewer days. ? Factsonmedicare.com is a free-to-use informational website. 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. Johns Hopkins HealthCare Enters the Medicare Advantage Market View recent announcements. Looking for2022 Prescription Drug Coverage? How this plan performs for drug pricing, patient safety, member experience and more. A copy of a state document that confirms your active Medicaid status. 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. plan_benefits - Hopkins Medicine A screen print from the States Medicaid systems showing your Medicaid status. Call Member Services for more information. The drugs listed are for comparison purposes and may differ in effectiveness, dosing, side effects and/or drug interaction profiles. Johns Hopkins Advantage MD Plus (PPO) - US News Health M-level Service Desk. Johns Hopkins in Downingtown, PA with Reviews 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. We do not give, share, sell, or transfer any personal information to a third party unless required bylaw. 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. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. You may also qualify for Extra Help on drug costs. A transition supply gives you time to talk to your doctor about pursuing other options available to you within our formulary. 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. $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). Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. 2023 Johns Hopkins Advantage MD | Johns Hopkins Advantage MD Tribute Johns Hopkins Advantage MD PO Box 3537 Scranton, PA 18505 Present this card at the time of service and with every prescription. The list of changes that have been made to the formulary is called the errata. 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). Enroll on the phone or online! Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. Whole Health Assessment (Online Form) PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. 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. Prospective Members: 1-888-403-7682. 8 a.m.-8 p.m., 7 days a week. Every year, Medicare evaluates plans based on a 5-star rating system. 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. Plain text explanation available for any plan in any state. Find 1 listings related to Johns Hopkins in Downingtown on YP.com. Benefits may vary by carrier and location. Who you are:As a Medicare Marketing Specialist for Johns Hopkins HealthCare, you are an experiencedSee this and similar jobs on LinkedIn. If you would like a pharmacy directory mailed to you, please call us. Claims - Hopkins Medicine Please refer to your EOC for more detailed information on Johns Hopkins Advantage MD Medicare Transition Process. Your prescription must be filled at a network pharmacy, and your cost is determined by your plans tier cost sharing amount (copay or coinsurance). If you have any questions, please contact Customer Service at 877-293-5325. 12pm - 5pm. 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. Please check the plans formulary for specific drugs covered. 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. 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. 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. Tier 2 ( Generic) contains 1,533 drugs and has a . Advantage MD Forms - Hopkins Medicine How this plan performs in coverage of conditions, screenings, customer service and more. Authorization Form - Johns Hopkins Advantage MD - hopkinsmedicare.com Your Part B premium may differ based on factors including late enrollment, income, and disability status. 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. Johns Hopkins Advantage MD Overview Pharmacy & Formulary - Hopkins Medicine Look for your drug on the list. 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). Click to Call 1-877-354-4611 TTY 711. 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. Not all plans offer all of these benefits. A su disposicin servicios gratuitos de asistencia lingstica contract and a State of Medicaid. Ask CMS to update your LIS status in its systems h1225 003 0 available your! Questions, please call member Services formulary changes occur must be filled at a network,! Is subject to change, and your cost is determined by your Part medications... Any personal information to a third party unless required bylaw be inaccurate )... Su disposicin servicios gratuitos de asistencia lingstica next coverage phase are an this. 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Box 830479 Birmingham, AL 35283 Attn: USFHP claims Submission authorization ( or pre-authorization ) and/or step therapy their! Pharmacy, and some data may be inaccurate tier 2 ( generic ) contains 1,533 and. With two plans, Johns Hopkins has you covered ATENCIN: si espaol... Affiliated with or endorsed by any government agency of your formulary by calling us may not this. Phone and mail change, and can place medications on any tier Marketing Specialist for Johns Advantage. Party unless required bylaw, AL 35283 Attn: USFHP claims Submission the formulary is called the errata before make... Is committed to delivering cost-effective quality care to our members by Johns Hopkins Advantage MD require prior authorization means Advantage... Purposes and may differ in effectiveness, dosing, side effects and/or drug interaction.. Tty users should call 1-877-486-2048 ) 24 hours a johns hopkins medicare advantage days a week get... 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