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Paramount Elite Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Enhanced (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Paramount Elite Enhanced (HMO-POS) in 2025, please refer to our full plan details page.
Paramount Elite Enhanced (HMO-POS) is a HMO-POS plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Greater Toledo OH and select SE MI counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Paramount Elite Enhanced (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Paramount Elite Enhanced (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Paramount Elite Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $68.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3100.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Paramount Elite Enhanced (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at standard mail pharmacies, but a $42 copay for standard generic drugs at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Paramount Elite Enhanced (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $225 for the first five days, and then no copay for the rest of the stay. Outpatient services have copays that range from $0 to $225, and emergency services have a $140 copay. This plan covers primary care with no copay, and specialist visits have a $30 copay. It also includes coverage for hearing aids, vision exams and eyewear, and dental services, with specific copays and benefit maximums. Additional benefits include ambulance and transportation services, home health services, and medical equipment, all with specific copays, coinsurance, and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $225 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with copays ranging from $0 to $225, and observation services with a $225 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a $35 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Paramount Elite Enhanced (HMO-POS) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Paramount Elite Enhanced (HMO-POS) plan. Ground and Air Ambulance Services have a $200 copay, while Transportation Services to a plan-approved health-related location has a $0 copay for up to 24 one-way trips per year using rideshares, bus/subway, or medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Paramount Elite Enhanced (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $35 copay, and there is no coinsurance for any of these services. Worldwide Emergency Services also includes Worldwide Urgent Coverage and Worldwide Emergency Transportation, both with a $140 copay.
Primary Care See details
The Paramount Elite Enhanced (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay. The plan also covers podiatry services, other health care professional, psychiatric services, physical therapy, speech-language pathology services and additional telehealth benefits with varying copays. Opioid treatment program services are covered with a $30 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay. Additional preventive services, kidney disease education, and other preventive services are covered with no copay for some sub-services. However, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, up to a maximum of $500 per year. Prescription hearing aids - inner ear, Prescription hearing aids - outer ear, Prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $30, and routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, with a combined maximum plan benefit coverage of $200 every year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Enhanced (HMO-POS) plan covers dental services with a $7,500 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments have no copay. Endodontics and prosthodontics, fixed have no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Paramount Elite Enhanced (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. For DME, there is no copay, and coinsurance ranges from 0% to 20%; however, Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. For Diabetic Supplies, there is a coinsurance that ranges from 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $10 copay, and Diagnostic Radiological Services with no copay. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Paramount Elite Enhanced (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Paramount Elite Enhanced (HMO-POS) plan. Despite the general coverage, specific services such as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Paramount Elite Enhanced (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, both with no copay, while Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items have a maximum plan benefit coverage amount of $162 every three months.
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