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Paramount Elite Prevail (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Prevail (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 Prevail (HMO-POS) in 2025, please refer to our full plan details page.
Paramount Elite Prevail (HMO-POS) is a HMO-POS plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Select Northern OH / 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 Prevail (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Paramount Elite Prevail (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 Prevail (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. Additionally, this plan comes with a Part B Premium reduction of $35.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4100.00 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
Prescription drugs are not covered by Paramount Elite Prevail (HMO-POS).
Additional Benefits
The Paramount Elite Prevail (HMO-POS) plan provides coverage for a variety of services, including inpatient and outpatient hospital care, with varying copays. It also covers ambulance services with a $250 copay, emergency services with a $140 copay, and offers no copays for primary care physician visits. Additional benefits include coverage for hearing, vision, and dental services, with specific copays and coinsurance amounts. The plan also covers home health services with no copay, and offers other benefits such as over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $300 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered, with a $300 copay for days 1-5 and no copay for days 6-90, while Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, Ambulatory Surgical Center (ASC) services with no copay, and outpatient substance abuse services, which includes individual and group sessions, both with a copay of $35. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Paramount Elite Prevail (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $250 copay and no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Paramount Elite Prevail (HMO-POS) plan. Emergency Services has a $140 copay, while Urgently Needed Services has a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $35 copay. Mental Health Specialty Services, Individual and Group Sessions both have a $35 copay. Podiatry Services have a copay between $10 and $35, and Other Health Care Professional services have a copay between $0 and $35. Psychiatric Services, Individual and Group Sessions both have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits have a copay between $0 and $35. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services include Health Education with no copay, and Nutritional/Dietary Benefit with no copay. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, the plan does not cover In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, and Telemonitoring Services.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams limited to 1 per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per year, and up to 2 hearing aid visits per year with no copay, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Paramount Elite Prevail (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Prevail (HMO-POS) plan offers dental services, including Medicare dental services with no coinsurance and other dental services with a $2,000 annual maximum. Oral exams and dental X-rays have no copay, while restorative services, adjunctive general services, endodontics, and periodontics have 30% coinsurance. Prosthodontics, implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Paramount Elite Prevail (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered by the Paramount Elite Prevail (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a coinsurance of 0-20% and no copay. Prosthetics, medical supplies, and diabetic equipment are also covered, with coinsurance requirements for some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services, with prior authorization required. Diagnostic Procedures/Tests have a $10 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Paramount Elite Prevail (HMO-POS) plan with no copay and no coinsurance. 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 Prevail (HMO-POS) plan. Despite the general coverage of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are specifically not covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Paramount Elite Prevail (HMO-POS) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Paramount Elite Prevail (HMO-POS) plan's other services include Over-the-Counter (OTC) Items, with a $0 copay and a maximum benefit of $100 every three months, as well as a Meal Benefit with no copay. 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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