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Paramount Elite Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Prime (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 Prime (HMO-POS) in 2026, please refer to our full plan details page.
Paramount Elite Prime (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 3.5 out of 5 stars in 2026.
It's important to know that Paramount Elite Prime (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 Prime (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 Prime (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 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 Prime (HMO-POS) Medicare plan features an annual drug deductible of $250. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order for both 1-month and 3-month supplies. For higher-tier medications, cost-sharing is based on a percentage of the drug cost rather than a flat copayment. Tier 3 (Preferred Brand) drugs require a 23% coinsurance, Tier 4 (Non-Preferred) drugs require a 40% coinsurance, and Tier 5 (Specialty) drugs require a 30% coinsurance for a 1-month supply.
Additional Benefits
The Paramount Elite Prime (HMO-POS) Medicare plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits. Specialist and therapy visits require a $25 copay, while inpatient hospital stays incur a $350 daily copay for the first five days and no copay for subsequent days. Outpatient services and emergency care are also covered with no coinsurance, including a $150 copay for emergency room visits. This plan also provides supplemental dental, vision, and hearing coverage with minimal out-of-pocket costs. Members receive dental services with no copay and no coinsurance up to a $3,000 annual limit, alongside no copay for annual routine eye exams and eyewear up to $200. Additional perks include up to 24 one-way transportation trips per year with no copay and a $110 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Paramount Elite Prime (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for day 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $310 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Paramount Elite Prime (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay of $0 to $325, observation services require a $270 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Paramount Elite Prime (HMO-POS) with a $25.00 copay and no coinsurance, although prior authorization is required for these services.
Ambulance and Transportation Services See details
Paramount Elite Prime (HMO-POS) covers ground and air ambulance services with a $295 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Paramount Elite Prime (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $25,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Paramount Elite Prime (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health services, and physical, occupational, and speech therapies require a $25 copay and no coinsurance. Telehealth, podiatry, and other healthcare professional services range from no copay up to a $25 copay with no coinsurance, though some chiropractic services are covered while routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by Paramount Elite Prime (HMO-POS), offering no copay and no coinsurance for most benefits like annual physical exams, though remote access technologies may require a copay of up to $25. Sub-services not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Paramount Elite Prime (HMO-POS) hearing services are partially covered, offering Medicare-covered and routine hearing exams for a $20 copay and no coinsurance, alongside annual hearing aid fittings with no copay. Prescription hearing aids are covered up to two per year with a copay of $499 to $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Paramount Elite Prime (HMO-POS) with no deductible, no coinsurance, and copays ranging from no copay to $20, though other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered. Covered benefits include one annual routine eye exam and eyeglasses (lenses and frames) or contact lenses with no copay, up to a $200 yearly limit.
Dental Services See details
Dental Services are partially covered by Paramount Elite Prime (HMO-POS) with no copay and no coinsurance up to a $3,000 annual maximum. While many preventive and comprehensive services are covered, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Paramount Elite Prime (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Paramount Elite Prime (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Paramount Elite Prime (HMO-POS) covers medical equipment with no copays, though coinsurance applies to several categories. Durable medical equipment and diabetic supplies carry a 0% to 20% coinsurance (with no coinsurance for therapeutic shoes or inserts), while prosthetic devices and medical supplies require a 20% coinsurance.
Diagnostic and Radiological Services See details
Paramount Elite Prime (HMO-POS) diagnostic and radiological services are partially covered and require prior authorization, with lab services being not covered. Covered diagnostic procedures and outpatient X-rays require a $15 copay with no coinsurance, while diagnostic radiological services have no copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Paramount Elite Prime (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Paramount Elite Prime (HMO-POS) covers some cardiac rehabilitation services with no coinsurance and prior authorization required. However, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Paramount Elite Prime (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance and requires no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Paramount Elite Prime (HMO-POS) partially covers other services, providing over-the-counter (OTC) items up to $110 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit, and prior authorization is required for the meal benefit.
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