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Paramount Elite Essential (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Essential (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 Essential (HMO-POS) in 2025, please refer to our full plan details page.
Paramount Elite Essential (HMO-POS) is a HMO-POS plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Counties in SW OH, Northern KY and SE IN. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Paramount Elite Essential (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 Essential (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 Essential (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 $3100.00 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 Essential (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy type, such as no copay for preferred generic drugs at standard mail pharmacies and $45 copay for standard generic drugs at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Paramount Elite Essential (HMO-POS) plan offers a range of benefits with varying cost-sharing. It includes coverage for inpatient and outpatient services, with copays depending on the specific service. You'll find coverage for primary care, preventive services, hearing, vision, and dental, with some services having no copay. This plan also covers ambulance services, emergency services, and home health services, with different copay amounts. Additional benefits include over-the-counter items, a meal benefit, and skilled nursing facility services. However, it's important to note that certain services like cardiac rehabilitation and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, the copay is $350, while there is no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $245, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Paramount Elite Essential (HMO-POS) plan, with a $35 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $300 copay, while transportation services to a plan-approved health-related location have no copay, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Paramount Elite Essential (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage and Emergency Transportation have a $135 copay, while Urgently Needed Services have a $35 copay.
Primary Care See details
Primary Care benefits for Paramount Elite Essential (HMO-POS) include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $35 copay for Occupational Therapy Services. Physician Specialist Services have a $35 copay, while Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have varying copays. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Additional Telehealth Benefits have a copay between $0 and $35.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications are covered, with varying details on copays. Other services such as in-home safety assessments, medical nutrition therapy, and more are not covered.
Hearing Services See details
The Paramount Elite Essential (HMO-POS) plan covers hearing exams with a $35 copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $675 per ear per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $35, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Essential (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and cleanings with no copay; fluoride treatments are covered with no copay. Endodontics and prosthodontics (fixed) are covered with no coinsurance, and oral and maxillofacial surgery is covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 Essential (HMO-POS) plan. You will pay a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Paramount Elite Essential (HMO-POS) plan. Durable medical equipment has a coinsurance between 0% and 20%, while prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies have a coinsurance between 0% and 20%. Durable medical equipment for use outside the home is not covered. Diabetic therapeutic shoes/inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $20 copay, and lab services with no copay. Diagnostic radiological services have a copay up to $150, while therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered under the Paramount Elite Essential (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 Essential (HMO-POS) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Paramount Elite Essential (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $200 copay for days 21-100.
Other Services See details
The Paramount Elite Essential (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit of $175 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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