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MedMutual Advantage Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Select (PPO) in 2026, please refer to our full plan details page.
MedMutual Advantage Select (PPO) is a PPO plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Ohio Regions. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that MedMutual Advantage Select (PPO) 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 MedMutual Advantage Select (PPO).
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 MedMutual Advantage Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. 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 has a $2000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $95.00 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 combined Maximum Out-Of-Pocket cost of $11300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $11300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 MedMutual Advantage Select (PPO) plan features a low $95 annual drug deductible and offers excellent savings on generic medications. You will pay no copay for Tier 1 preferred generics at preferred pharmacies and preferred mail-order services, as well as no copay for Tier 6 select care drugs across all pharmacy types. Generic drugs in Tier 2 are also highly affordable, starting at just a $4 copay for a one-month supply through preferred mail order or $5 at preferred retail pharmacies. For higher-tier medications, this plan transitions to coinsurance rather than flat copayments. You will pay 23% coinsurance for Tier 3 preferred brand drugs and 43% coinsurance for Tier 4 non-preferred drugs across all standard and preferred pharmacies. Specialty medications in Tier 5 require a 31% coinsurance for a one-month supply, regardless of whether you use retail or mail-order pharmacies.
Additional Benefits
The MedMutual Advantage Select (PPO) plan offers robust coverage with no coinsurance for inpatient hospital stays, which require a $385 daily copay for the first five days and no copay for subsequent days. Routine medical care is highly accessible, featuring a low $5 copay for primary care visits, a $30 copay for specialists, and no copay or coinsurance for annual physicals and preventive screenings. Emergency room visits carry a $115 copay, while urgent care services require a $40 copay, both with no coinsurance. For specialized care, routine dental, vision, and hearing exams are available with no copay or coinsurance, alongside covered home health services and over-the-counter items. Skilled nursing facility care is also highly affordable, requiring no copay for the first 20 days, while medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, members can benefit from up to 24 one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
MedMutual Advantage Select (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1 to 5 of acute stays (no copay for days 6 and beyond) and a $370 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and the benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
MedMutual Advantage Select (PPO) covers outpatient services with no coinsurance, featuring a $380 copay for outpatient hospital and ambulatory surgical center services, and a $385 copay per stay for observation services. Outpatient substance abuse services are covered with a $30 copay and no coinsurance, while outpatient blood services require no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the MedMutual Advantage Select (PPO) plan with a $30.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MedMutual Advantage Select (PPO), with ground ambulance services requiring a $235 copay (no coinsurance) and air ambulance services requiring a 50% coinsurance (no copay). Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by MedMutual Advantage Select (PPO) with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care has a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Select (PPO) covers primary care visits for a $5 copay and specialist visits for a $30 copay, both with no coinsurance. While telehealth, mental health, and physical therapies are covered with low copays and no coinsurance, podiatry and chiropractic services are not covered, and opioid treatment requires no copay and 20% coinsurance.
Preventive Services See details
MedMutual Advantage Select (PPO) covers annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. Additional preventive services are partially covered with no copay—excluding weight management programs which require a 70% coinsurance—while sub-services like health education, alternative therapies, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by MedMutual Advantage Select (PPO), which features routine hearing exams once per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $499.00 to $999.00, but hearing aid fittings, OTC models, and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by MedMutual Advantage Select (PPO), offering one routine eye exam per year with no copay and no coinsurance. Eyewear is covered up to a $100 annual limit with no copay and a 20% coinsurance for contact lenses, though other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MedMutual Advantage Select (PPO), with Medicare-covered dental services requiring a $30 copay and no coinsurance. Preventive care like cleanings, exams, x-rays, and fluoride treatments has no copay and no coinsurance, but other preventive, restorative, orthodontic, endodontic, periodontic, prosthodontic, implant, and oral surgery services are not covered.
Home Infusion bundled Services See details
MedMutual Advantage Select (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and insulin, require a coinsurance of 0% to 20%, with insulin drugs also having a $35 copay.
Dialysis Services See details
MedMutual Advantage Select (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Select (PPO) covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes. Covered diabetic supplies range from no coinsurance up to a 20% coinsurance, and prior authorization is required for certain equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by MedMutual Advantage Select (PPO) with prior authorization required. Diagnostic procedures and lab services require a $10 copay with no coinsurance, outpatient X-rays require a $50 copay, diagnostic radiological services carry a minimum $100 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the MedMutual Advantage Select (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MedMutual Advantage Select (PPO) covers some Cardiac Rehabilitation Services with no coinsurance and prior authorization required, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry copays ranging from $20.00 to $30.00.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by MedMutual Advantage Select (PPO) 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, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by MedMutual Advantage Select (PPO), with acupuncture excluded from coverage. Over-the-counter items and meal benefits are covered with no copay and no coinsurance, while the MedMutual Advantage Travel Plus benefit has a copay of $0 to $400 and 0% to 50% coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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