A non-government entity
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 2025, 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 4 out of 5 stars in 2025.
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 $27.00. 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 $3300.00 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:
Sign up for Paramount Elite Prime (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Paramount Elite Prime (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays for your prescriptions depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard or mail pharmacy. You will pay a $45 copay for standard generic drugs, and a $100 copay for preferred brand drugs at a standard pharmacy.
Additional Benefits
The Paramount Elite Prime (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but some days have no copay, and outpatient services have copays ranging from $0-$200. The plan also includes coverage for ambulance, emergency, and primary care services, with no copays for some services. Preventive, hearing, vision, and dental services are included, often with no copays or limited copays, and some services have annual limits. The plan also covers home infusion, dialysis, medical equipment, and home health services. Additional benefits include OTC items, meal benefits, and transportation services.
Inpatient Hospital See details
The Inpatient Hospital benefit covers inpatient hospital stays, including services not usually covered by Medicare plans, with a copay of $310 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 are not covered. Inpatient Hospital Psychiatric benefits are covered with a copay of $310 for days 1-5 and no copay for days 6-90, while additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $200, and observation services with a $270 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $35 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Paramount Elite Prime (HMO-POS) plan with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Paramount Elite Prime (HMO-POS) plan. Ground and air ambulance services have a $250 copay, and transportation services to plan-approved health-related locations are covered with no copay, up to 24 one-way trips per year, with rideshare services, 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services have a $35 copay; all have no coinsurance.
Primary Care See details
The Paramount Elite Prime (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $25 copay, and physician specialist services have a $20 copay. Mental health specialty services, including individual and group sessions, have a $20 copay. Podiatry services and routine foot care have a $20 copay, and other health care professional services have a $0-$20 copay. Individual and group psychiatric sessions have a $20 copay. Physical therapy and speech-language pathology services have a $25 copay. Additional Telehealth Benefits have a $0-$20 copay, and Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional services such as health education, nutritional/dietary benefits, smoking cessation, fitness benefits, enhanced disease management, remote access technologies, and home and bathroom safety devices. Some services such as In-Home Safety Assessment, Medical Nutrition Therapy, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams are limited to one per year. Fitting/evaluation for hearing aids are covered with no copay and are limited to one per year. Prescription hearing aids are covered, with a maximum benefit of $500 per year, and prescription hearing aids (all types) are covered with no copay, limited to two per year; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Routine eye exams have no copay, and you are eligible for one exam per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), have no copay, but there is a combined maximum plan benefit of $200 per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Prime (HMO-POS) plan covers dental services, including oral exams, dental x-rays, cleanings, and fluoride treatments with no copay, but has limits on the number of visits and periodicity. Other covered services include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with some limitations on the number of visits and periodicity. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Paramount Elite Prime (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with a coinsurance between 0% and 20%, 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 under the Paramount Elite Prime (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Paramount Elite Prime (HMO-POS) plan, including Durable Medical Equipment with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are covered with a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services with the Paramount Elite Prime (HMO-POS) plan includes coverage for Diagnostic Procedures/Tests with a $15 copay, and Diagnostic Radiological Services with no copay. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Paramount Elite Prime (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 Prime (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 Prime (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Paramount Elite Prime (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $155.00 every three months, and Meal Benefits 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved