2 hearing aids per year when purchased through TruHearing, 3 follow-up visits with an in-network provider for fitting and adjustment of hearing aids, 3-year manufacturer warranty for repairs and one-time loss and damage replacement, 48 batteries per aid included with non-rechargeable models. 20% coinsurance for chronic lower back pain. 0000024692 00000 n
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Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. The Advantage MD formularies are subject to change at any time upon Medicare approval. 0000088113 00000 n
LA - Limited Access, available only at certain pharmacies per manufacturers restriction. 0000024509 00000 n
A dental checkup is good for cleaning your teeth and gums and checking the health of your mouth. 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. 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. Our mail order pharmacy, CVS/caremark, can help. It will cost $301 per month in 2022. Advantage MD utilizes multiple formularies which have different cost sharing tiers. 10]J00}e0 *=
Members can have OTC products mailed to their homes once a quarter after placing an order online or via the OTC Program call center at 1-888-628-2770. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. 1 in the medicare advantage (ma) program, which currently covers just over a third of medicare beneficiaries, plans are able to offer supplemental coverage by Johns Hopkins Advantage MD.
Dental Plans (EHP) | Human Resources | Johns Hopkins Hospital & Health Johns Hopkins OnDemand Virtual Care gives members 24/7 access to care for minor medical concerns. How is Advantage MD different from other Medicare Advantage plans? Initial Coverage Phase After you pay your deductible, if applicable, up to the initial coverage limit of $4,430. Tier Exceptions can be requested to provide the drug at a lower cost-sharing tier when the drugs at a lower copayment level have been tried and failed or are contraindicated. %PDF-1.7
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Look up plan benefits Part A and Part B are also known as "Original Medicare".
Johns Hopkins Advantage MD Overview Certain products are identified in the catalog as Dual-Purpose. When you join Advantage MD (HMO) Advantage MD (PPO) and Advantage MD Plus (PPO): You can purchase an optional supplemental package that includes comprehensive dental for an additional $25 a month. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. * Not available as extended days' supply (greater than 30 days' supply). Notice of Nondiscrimination: Johns Hopkins Advantage MD (PPO) and Johns Hopkins Advantage MD (HMO) comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 0000012661 00000 n
Get help from a licensed Medicare agent. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security. Clinical documentation should be provided to support all requests. Cost savings does not apply in the catastrophic phase. hb``g``4Ab@c,-::8d$K'1D=E-e\
=lDfg Q N)%0EnL ov A Cumulative Morphine Milligram Equivalent (cMME) Edit (aka Care Coordination Edit), This rejection will occur if the cMME dose is. 0
2. list for the requested drug criteria. 2. They will fax you a drug specific questionnaire for you to complete and return via fax. . It is the ordering providers responsibility to determine which specific codes require prior authorization or have step therapy. Whole Health Assessment Form Whole Health Assessment (Online Form) PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. Available for an extra premium ($25) for comprehensive dental. 0000088183 00000 n
To file a request by phone, call Customer Service toll-free, 24 hours a day, seven days a week. Select Insulins:BASAGLAR KWIKPENFIASP, FIASP FLEXTOUCH, FIASP PENFILLLEVEMIR, LEVEMIR FLEXTOUCHNOVOLIN 70/30, NOVOLIN 70/30 FLEXPENNOVOLIN N, NOVOLIN N FLEXPENNOVOLIN R, NOVOLIN R FLEXPENNOVOLOG MIX 70/30, NOVOLOG 70/30 FLEXPEN, NOVOLOG MIX 70/30 PREFILLNOVOLOG, NOVOLOG FLEXPEN, NOVOLOG PENFILLSOLIQUA 100/33TRESIBA,TRESIBA INJ, TRESIBA FLEXTOUCHXULTOPHY 100/3.6HUMULIN R U-500, HUMULIN R U-500 KWIKPEN (30-day supply only). Hearing Vision Dental.
Older adults in Baltimore unexpectedly dropped from private Medicare 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. Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD (PPO) offered by Johns Hopkins Advantage MD. 0000789385 00000 n
2022 Johns Hopkins HealthCare | Johns Hopkins Advantage MD (PPO) | US News 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. 0000209546 00000 n
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If a non-preferred product is required, an organization determination must be submitted. The comprehensive dental benefit for the Johns Hopkins Advantage MD Premier (PPO) plan has a $1,500 Annual Maximum. The network includes most chain retailers and independent pharmacies.
LifeBridge Health Becomes Part Owner In Johns Hopkins Medicare Formulary changes will be reflected in the updated formularies and in the formulary changes lists below. such as prescription drug coverage, dental and vision coverage, and even gym memberships. Contact us or find a patient care location. If a request is denied, an appeal or a redetermination may be filed within 60 calendar days from the date of the first decision. Search health topics in theHealth Library. If you want a Provider or Pharmacy Directory mailed to you, or if you need help finding an in-network provider, please call Customer Service, October 1 through March 31, Monday through Sunday, 8 a.m. to 8 p.m., and April 1 through September 30, Monday through Friday, 8 a.m. to 8 p.m. PPO network: call 877-293-5325 (TTY: 711) HMO network: call . The retail pharmacy network includes over 65,000 pharmacies nationwide. Hearing Vision Dental.
The High Coverage of Dental, Vision, and Hearing Benefits Among 0000034216 00000 n
Search for a Provider. This rejection may be overridden by the pharmacist but they may contact the prescriber for confirmation or request prescribers to submit a Coverage Determination. Talk to your patients today about mail order pharmacy with CVS/caremark for better health and health care spending. If the drug is not listed, it does not require prior authorization. 0000034145 00000 n
Medicare Advantage with Part D plan details and help for Johns Hopkins Advantage MD (HMO) offered by Johns Hopkins Advantage MD.
These point-of-sale edits are safety edits and not intended as prescribing limits. Foreign Language Assistance: Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 0000031441 00000 n
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. Log in to your HealthLINK account to view information on yourUSFHP patients. If you are not able to pay your bill in full, you may qualify for a payment plan and/or financial assistance. Supplies like meters, lancets, and test strips can be purchased at a network pharmacy, but nebulizers and other equipment must be purchased through a DME vendor. Review quality measures. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. This page was last updated: October 1, 2022 at 4:23 am EST. 0000034945 00000 n
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Johns Hopkins Advantage MD (HMO) has an in-network out-of-pocket maximum of $7,550. Information may need to be submitted describing the use and setting of the drug to make the determination. Spanish.
Johns Hopkins Medicine and CareFirst Reach New Strategic Agreement 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. Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing.
Benefits and Coverage - Johns Hopkins Employer Health Programs (EHP) Johns Hopkins Advantage MD D-SNP (HMO) has an in-network out-of-pocket maximum of $7,550. Comprehensive dental included at no additional cost. Our formularies are updated on a monthly basis or whenever formulary changes occur. 0000209902 00000 n
Select Insulins are indicated on the Drug List with SI. Search the Advantage MD Part B Prior Authorization Criteria. PPO/Plus PPO/Premier PPO formulary search toolHMO formulary search toolD-SNP (HMO) formulary search tool. Oct. 1 through Mar. Use this search tool to find doctors, hospitals, prescription drugs, and pharmacies within the Advantage MD network. xref
Masks are required inside all of our care facilities. Member cost share for Select Insulins will be $35 for a one-month supply and up to $105 for a three-month supply with additional savings for mail order. Step Therapy Exceptions can be requested when there is contraindication to the prerequisite medication or there is documented trial and failure of prerequisite medication. This rejection may be overridden by the pharmacist but they may contact the prescriber for confirmation.
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) Formulary Exceptions can be requested when a medical condition warrants use of certain medications not on the formulary. Silver&Fit and the Silver Slate are federally registered trademarks of ASH and used with permission herein. 0000027093 00000 n
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PDF Johns Hopkins Advantage MD (PPO) Frequently Asked Questions Kaiser Permanente Medicare Advantage Plans with Part D in Maryland This rejection will occur when prescribed drugs have the same therapeutic effects as medication(s) the Part D Enrollee is currently taking (i.e.
Johns Hopkins Healthcare Drops Medicare Coverage for Nearly 6,000 This insulin is part of the Senior Savings Model Program. You may also search for a specific drug in one of our formularies using our formulary search tools. Members are responsible for the difference between the allowed amount and the billed amount. Generic drugs are listed in italic type in the formulary. For prescription drug on formulary at in-network pharmacy. 0000088281 00000 n
hb``c``e`a`xAb@qa5DIq@GGkhZGD(_XQ3$ACr1` The searchable formulary may not include all covered drugs. endstream
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PDF Supplemental Dental Plan - hopkinsmedicare.com Advantage MD recently launched the Johns Hopkins Advantage MD Benefits Explorer, an interactive tool designed to help Advantage MD members quickly and easily find coverage information related to specific services. 0000789307 00000 n
Not all plans offer all of these benefits. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal. Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. . 0000034857 00000 n
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. Medicare Advantage plan information for Johns Hopkins Advantage MD (HMO) by Johns Hopkins HealthCare. Information on Coronavirus (COVID-19) At Advantage MD, we want to make sure you have accurate information, know what to expect, and are empowered to care for your own and your family's health. 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. Enroll . This means your patient can fill a100-day supply of Tier 1 medication and a 90-day supplyof Tier 2 through 4 medication for only 2 times the retail copaysaving them an equivalent of four retail copays per year. The comprehensive dental benefit for the Optional Supplement benefits for the Johns Hopkins Advantage MD (HMO) plan has a $1,000 Annual Maximum. Excited about the expansion of Johns Hopkins Advantage MD Medicare Advantage products in 2023. Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. Every October we offer an open enrollment period where you can switch plans, add or remove family members, or opt in or out of coverage. %PDF-1.7
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Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. 0000803559 00000 n
Cost Sharing Tier 3: Preferred Brand Drugs have an intermediate out-of-pocket cost for members. The Hopkins Medicare Advantage plan will continue to be offered in 10 other Maryland counties.
Johns Hopkins Advantage MD Plus (PPO) - Health Plan Radar Johns Hopkins Advantage MD Medicare Plans | Health Plan Radar The comprehensive dental benefit for the Johns Hopkins Advantage MD D-SNP (HMO) plan has a $500 Annual Maximum. Additional Coverage. Enter the last name, specialty or keyword for your search below. 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). If you have any questions, please contact Customer Service at 877-293-5325. View recent announcements. Explanation of Hearing Aid Coverage Johns Hopkins Advantage MD covers up to two hearing aids per year when purchased through TruHearing. 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. 0000002364 00000 n
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10,000+ Maryland Providers Variety of Medicare Plans Advantage MD Care Team
PPO Step Therapy CriteriaHMO Step Therapy CriteriaD-SNP (HMO) Step Therapy Criteria. 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. 0000002419 00000 n
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$200/day copay for days 1-5; $0 copay for days 6-90; $10 copay once per year; up to $300 allowance for additional eyewear every two years. With the Silver&Fit Healthy Aging and Exercise program, you can choose either a fitness center membership at a participating fitness center or the Silver&Fit Home Fitness Program. Only non-Low Income Subsidy (LIS) enrollees are eligible for the reduced cost-sharing. If you have any questions, call Customer Service: PPO patients: 877-293-5325 (option 2)HMO and D-SNP patients: 877-293-4998 (option 2). 0000035096 00000 n
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. Health Plan Radar. 0000002545 00000 n
The following section will describe these benefits in detail. Cost Sharing Tier 2: Generic Drugs have a low out-of-pocket cost for members.
Johns Hopkins Advantage MD Medicare Advantage Plans with Part D PPO Prior Authorization CriteriaHMO Prior Authorization CriteriaD-SNP (HMO) Prior Authorization Criteria.
document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get your FREE Medicare Guidebook when signing up! Please refer to the pharmacy prescription benefit section of the Provider Manual or the plan's member website vaccine coverage page. 0000085838 00000 n
Advantage MD Part B Prior Authorization Criteria. If your plan includes dental coverage, routine care and certain procedures are covered for you and your family. *Please note: this information does not apply to AdvantageMDGroup. SI - Select Insulin. care coverage, acupuncture allowances, and additional benefits beyond Original Medicare. 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. The provider may request an exception to the step therapy for specific circumstances that warrant a need for a non-preferred product. Download the applicable Request for Medicare Prescription Drug Coverage Determination form below, complete, and send with clinical supporting documentation. If you have questions about Johns Hopkins Advantage MD or require assistance in selecting a PCP, please call our Customer Service Department at 1-877-293-5325.
Johns Hopkins Advantage MD Primary (PPO) | Medicare Plan Details & Help Find a Provider or Pharmacy | Johns Hopkins Advantage MD 0000085364 00000 n
How do I determine if a specific treatment requires prior authorization or has step therapy? 0000113770 00000 n
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Call 1-877-354-4611 TTY 711. Doctors and staff can contact CVS/caremark by calling the number below, 24 hours a day, seven days a week. CVS/caremark mail order pharmacy provides mail order requests to members. 97 0 obj
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Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227).
Please utilize HealthLINK to submit prior authorization requests or step therapy exceptions for Medicare Part B drugs. Certain medications are required to satisfy specific step therapy criteria. Read more about coronavirus. member is filling opioids and benzodiazepines). 8 a.m.-8 p.m., 7 days a week. 0000015610 00000 n
$300 supplemental benefit for any injury or illness. Advantage MD is a health insurance plan that provides Medicare benefits through the nonprofit corporation Johns Hopkins Healthcare LLC.
The High Coverage of Dental, Vision, and Hearing Benefits Among 0000111876 00000 n
Excited about the expansion of Johns Hopkins Advantage MD Medicare Advantage products in 2023. 0000028930 00000 n
Advantage MD Forms - Hopkins Medicine 0000022582 00000 n
Nearly 6,000 seniors will lose coverage.
PDF Johns Hopkins Advantage MD (PPO) Quick Reference Guide Contact JHHC. 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. 84 0 obj
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From April 1September 30, you will need to leave a message on weekends and holidays. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prior Authorization, Quantity Limits, and Step Therapy, Select Insulins for Reduced Copays New 2022 Benefit, Over the Counter Program New 2022 Benefit, Advantage MD PPO/Plus PPO/Premier PPO Formulary, PPO/Plus PPO/Premier PPO Errata (list of formulary changes), D-SNP (HMO)Errata (list of formulary changes), PPO/Plus PPO/Premier PPO formulary search tool, Request for Medicare Prescription Drug Coverage Determination form, PPO Prescription Drug Coverage Determination Request, HMO and D-SNP Prescription Drug Coverage Determination Request, HMO and D-SNP Step Therapy Exception Request, HMO and D-SNPQuantity Limit Exception Request, HMO and D-SNPFormulary Exception Request, PPO Prescription Drug Coverage Redetermination Request, HMO Prescription Drug Coverage Redetermination Request, specific codes require prior authorization or have step therapy, Advantage MD Part B Prior Authorization Drug. The following Johns Hopkins Advantage MD plans offer Medicare Advantage Prescription Drug plan coverage to Maryland residents. A top-tier PPO, which features comprehensive dental coverage, is only offered in Montgomery County. Quantity Exceptions can be requested when a medical condition warrants use of quantities greater than listed quantities for each drug. Health Plan Radar . Cost Sharing Tier 4: Non-Preferred Drugs have a higher out-of-pocket cost for members. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. 0000000016 00000 n
Johns Hopkins Advantage MD covers both Medicare Part B and Part D medications. Medicare plans are available to all Medicare beneficiaries. Certain medications have specific dispensing limitations for quantity and maximum dose. Submit the prior authorization request or the step therapy exception utilizing Advantage MDs HealthLINK Secure Provider Portal. So wherever life takes you, we're here to help. LIS members will pay their normal LIS copay for the Select Insulins. 98 0 obj
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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. Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients. Look for the drug on the list. For official federal government information, please visit Healthcare.gov or Medicare.gov (1-800-MEDICARE). For a complete comparison of which medications are covered by which part, please refer to the Medicare Part B vs. Part D chart. 0000209468 00000 n
The prior authorization program is managed in collaboration with CVS HealthNovoLogix. Questions About Dental Benefits? Johns Hopkins Advantage MD (PPO) Frequently Asked Questions Provider Relations Department: 1-888-895-4998 . All Medicare Advantage and Part D Plans Facts . Have Questions About Your Bill? Advantage MD covers up to $90 every three months for D-SNP (HMO) members and up to $60 every three month for HMO members. The Advantage MD catalog for OTC items is available online at www.hopkinsmedicare.com. Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. PPO members: 877-293-5325 (option 2)HMO members: 877-293-4998 (option 2). 0000013598 00000 n
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For more information, please review the Evidence of Coverage. Download Female dentist examining patient with dental assistant, Munich, Bavaria, Germany Stock Photo and explore similar images at Adobe Stock. Several of our plans now start at $0 a month with doctor's visits as low as $0 and include . With so many benefits, it's important to understand your Advantage MD coverage to get the most out of your health care. This rejection will occur when interacting drug combinations are identified (i.e. Johns Hopkins Advantage MD (PPO) has an in-network out-of-pocket maximum of $7,550 and a combined in- and out-of-network maximum of $11,300. 0000020459 00000 n
8(Ly *Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. 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 Advantage with Part D plan details and help for Johns Hopkins Advantage MD Premier (PPO) offered by Johns Hopkins Advantage MD. EHP/Priority Partners/Advantage MD patients, NM - Not available at mail-order pharmacies. Specialty Tier drugs have a coinsurance and are limited to a 30 day supply. Give us a call (410) 896-1212. Established criteria are based on medical literature, physician expert opinion, and Food and Drug Administration (FDA) approved labeling information. Enrolling is quick and easy. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. hbbd``b`z $s6qg$&7C $X@ I BHpG bKe+Hq$3012liHg O]
For more information, please review the Evidence of Coverage. Mon-Fri 8am-9pm EST .
Understand Your Advantage Plan Benefits | Johns Hopkins Advantage MD To find a participating fitness center, you can search for the closest Silver&Fit fitness centers to you on the Silver&Fit website at. The plans website includes apharmacy locator for members and providers to easily locate participating pharmacies. 0000216199 00000 n
You are about to leave the Johns Hopkins Advantage MD website. 63 0 obj
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Those having their benefits terminated will lose access to reduced prices for prescriptions, better copays, and access to vision and dental benefits. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. Please note: the information in this section does not apply to AdvantageMD Group. Johns Hopkins Advantage MD PPO, Advantage MD Plus PPO, Advantage MD Premier PPO, . Find more COVID-19 testing locations on Maryland.gov. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System.