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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 2025, 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 out of 5 stars in 2025.
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 has an enhanced alternative drug benefit. The plan has a $95.00 deductible. In the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a preferred generic drug, you will pay a $5.00 copay at a preferred pharmacy. After your total drug costs reach $2,000.00, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The MedMutual Advantage Select (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and partial hospitalization. Emergency services, primary care, preventive services, hearing, vision, and dental services are also covered, often with copays or coinsurance. The plan also includes coverage for ambulance, home infusion, dialysis, medical equipment, and diagnostic services. This plan provides additional coverage for services like transportation, home health, and skilled nursing facilities. However, it's important to note that certain services, such as cardiac rehabilitation, and some dental, vision, and hearing services are not covered. The plan also has some limitations on coverage for specific items, like OTC items and certain home health services.
Inpatient Hospital See details
The MedMutual Advantage Select (PPO) plan covers inpatient hospital stays, with a copay of $400 per day for days 1-5 and no copay for days 6-90 for acute inpatient hospital stays; inpatient psychiatric stays have a copay of $370 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital acute are covered, while non-Medicare-covered stays and upgrades for inpatient hospital acute and additional days and non-Medicare-covered stays for inpatient psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $380 copay, observation services with a $385 copay, and ambulatory surgical center services with a $350 copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $40, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MedMutual Advantage Select (PPO) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 50% coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the MedMutual Advantage Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered, and the plan has a maximum benefit of $50,000 for Worldwide Emergency Services.
Primary Care See details
The MedMutual Advantage Select (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $35 copay. This plan also covers mental health specialty services, physical therapy, speech-language pathology services with a $40 copay, additional telehealth benefits with a $5-$35 copay, and opioid treatment program services with 20% coinsurance.
Preventive Services See details
The MedMutual Advantage Select (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, weight management programs with a 70% coinsurance, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, 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, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams, with one exam covered every year, but fitting/evaluation for hearing aids is not covered. Prescription Hearing Aids (all types) are covered, with a copay between $499 and $999 for up to two visits per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC Hearing Aids are not covered.
Vision Services See details
The MedMutual Advantage Select (PPO) plan covers vision services, including routine eye exams once per year, with no deductible and no copay. Eyewear is covered with a 20% coinsurance for contact lenses, and a combined maximum benefit of $100 per year for both in-network and out-of-network services. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for oral exams with a $35 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MedMutual Advantage Select (PPO) and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Select (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered under the MedMutual Advantage Select (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance with no copay. Diabetic Equipment has a coinsurance, with Diabetic Supplies having a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts having a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $10, Lab Services with no copay, Diagnostic Radiological Services with a copay between $100 and $175, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by MedMutual Advantage Select (PPO) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MedMutual Advantage Select (PPO) 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 by the MedMutual Advantage Select (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MedMutual Advantage Select (PPO) plan's Other Services benefit includes Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, and Other 1 with a coinsurance between 0% and 50% and a copay between $0 and $400. 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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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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