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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Paramount Elite Standard (HMO-POS) is a HMO-POS plan offered by Paramount Care, Inc. available for the 2026 plan year to people living in Greater Toledo OH and select SE MI counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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
Health deductible: information not available.
This plan has a $225.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4600.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4600.00 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) Medicare plan features an annual prescription drug deductible of $225. Beneficiaries will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard retail pharmacies or through standard mail-order services for both 1-month and 3-month supplies. For brand-name and specialty prescriptions, costs are based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 20% coinsurance, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs carry a 30% coinsurance for a 1-month supply.
Additional Benefits
The Paramount Elite Standard (HMO-POS) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health care. For specialized care, members will pay copays ranging from $10 to $35 for specialist visits, and enjoy covered dental services with no copay up to a $3,000 annual maximum. Inpatient hospital stays require a $350 daily copay for days one through six, while outpatient hospital services range from no copay up to a $350 copay. Additional benefits include routine vision exams and select eyewear with no copay up to a $200 annual limit, plus routine hearing exams with a $20 copay. Emergency services carry a $130 copay, and the plan covers up to 24 one-way transportation trips per year to plan-approved locations with no copay. Members also receive a $60 quarterly over-the-counter allowance and pay no copay for durable medical equipment, which is subject to a 0% to 25% coinsurance.
Inpatient Hospital See details
Paramount Elite Standard (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a copay of $350 per day for days 1-6 of acute stays and $325 per day for days 1-5 of psychiatric stays, with no copay for remaining covered days. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Paramount Elite Standard (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which both have no copay. Outpatient hospital services require a copay ranging from $0 to $350, while outpatient substance abuse sessions have a $35 copay and observation services carry a $275 copay per stay.
Partial Hospitalization See details
Paramount Elite Standard (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Paramount Elite Standard (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Paramount Elite Standard (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within one day, and no coinsurance. Urgently needed services require a $35 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Paramount Elite Standard (HMO-POS) feature no copay and no coinsurance for primary care visits, while specialist visits, therapies, mental health, and podiatry services require copays ranging from $10 to $35 with no coinsurance. Routine and other chiropractic services are not covered under this plan.
Preventive Services See details
Paramount Elite Standard (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes self-management. While supplemental benefits like memory fitness and nutritional counseling are covered at no cost, several sub-services—including medical nutrition therapy, weight management programs, and in-home safety assessments—are not covered.
Hearing Services See details
Paramount Elite Standard (HMO-POS) covers annual routine hearing exams for a $20 copay and fitting evaluations with no copay, both with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999, while over-the-counter, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Paramount Elite Standard (HMO-POS) offers partially covered vision services with no deductibles and no coinsurance. While one routine eye exam per year and select eyewear—including contact lenses and eyeglasses (lenses and frames)—are covered with no copay up to a $200 annual limit, other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Paramount Elite Standard (HMO-POS) with no copay and no coinsurance for covered services up to a $3,000 annual maximum. However, other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Paramount Elite Standard (HMO-POS) with no copay and no coinsurance, though prior authorization and step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and radiation, require no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Paramount Elite Standard (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under Paramount Elite Standard (HMO-POS) with no copays, featuring 0% to 25% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic supplies carry a 0% to 20% coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Paramount Elite Standard (HMO-POS) because lab services are not covered. Covered diagnostic procedures require a $20 copay and no coinsurance, while radiological services require prior authorization and range from diagnostic radiology with no copay or coinsurance to therapeutic radiology with a 20% coinsurance and outpatient X-rays with a $20 copay.
Home Health Services See details
Home health services are covered under the Paramount Elite Standard (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Paramount Elite Standard (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Paramount Elite Standard (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Paramount Elite Standard (HMO-POS), which provides a $60 quarterly over-the-counter allowance and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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