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Paramount Elite Standard (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Standard (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 Standard (HMO-POS) in 2025, please refer to our full plan details page.
Paramount Elite Standard (HMO-POS) is a HMO-POS plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Counties in NE OH, SE MI, NE OH, and NE IN. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Paramount Elite Standard (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 Standard (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 Standard (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $3500.00 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 Standard (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay the following costs for drugs in each tier until your total drug costs reach $2000. For preferred generic drugs, there is no copay at standard and mail order pharmacies. For standard generic drugs, the copay is $45.00. For preferred brand drugs, the copay is $100.00. Non-preferred drugs have a 33% coinsurance.
Additional Benefits
The Paramount Elite Standard (HMO-POS) plan offers comprehensive coverage with a variety of benefits. You'll have no copay for many services, including primary care visits, preventive services, home health services, and dental cleanings. The plan also covers inpatient hospital stays with a $325 copay for the first five days, outpatient services with copays ranging from $0 to $275, and emergency services with a $140 copay. Additional benefits include hearing and vision coverage, with hearing exams costing $20 and vision exams with a copay of $0 to $20. The plan also covers ambulance services with a $250 copay, and offers an over-the-counter allowance of up to $150 every three months. Some services, like cardiac rehabilitation and certain dental and vision services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $325 copay 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 Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $275, while observation services have a $275 copay. Ambulatory surgical center services and outpatient blood services have no copay, and outpatient substance abuse services have a copay of $35 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Paramount Elite Standard (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 Standard (HMO-POS) plan. Ground and Air Ambulance Services have a $250 copay, while Transportation Services to a Plan Approved Health-related Location has no copay and covers 24 one-way trips per year via Rideshare Services, Bus/Subway, and Medical Transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Paramount Elite Standard (HMO-POS) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $35 copay, and Worldwide Emergency Services have a $140 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Paramount Elite Standard (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $20 copay, mental health specialty services with a $20 copay for individual and group sessions, podiatry services with a $10-20 copay, other health care professional services with a $0-20 copay, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $0-20 copay, and opioid treatment program services with a $20 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, as well as additional services such as health education, nutritional/dietary benefits, smoking cessation counseling, and fitness benefits, all with no copay. Other covered services include kidney disease education and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Some services like in-home safety assessments, medical nutrition therapy, and counseling services are not covered.
Hearing Services See details
The Paramount Elite Standard (HMO-POS) plan covers hearing exams with a $20 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered, with a limit of one visit per year and no copay. Prescription hearing aids are covered up to $500 per year, with two visits allowed per year and no copay, however, inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0 to $20. Eyewear is also covered, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $200 per year and no copay. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Standard (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, all with no copay, and also covers prosthodontics (fixed) with no coinsurance. Other services, such as maxillofacial prosthetics, implant services, and orthodontics, are not covered, and the plan has a $6,000 maximum benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 Standard (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Paramount Elite Standard (HMO-POS) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $20 copay, while Lab Services are not covered. Diagnostic Radiological Services have a $0 copay, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Paramount Elite Standard (HMO-POS) plan with no copay and no coinsurance; however, 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 Standard (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Paramount Elite Standard (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $186 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Paramount Elite Standard (HMO-POS) plan's other services include Over-the-Counter (OTC) Items with no copay, up to $150 every three months, and a meal benefit with no copay; however, 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.
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