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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 $93.00. 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 deductible of $95.00. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $5.00 copay at a preferred pharmacy, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The MedMutual Advantage Select (PPO) plan offers comprehensive coverage, including inpatient hospital stays with copays, outpatient services, and partial hospitalization. You'll have access to primary care, preventive services, and coverage for hearing, vision, and dental services. The plan also covers ambulance services, emergency care, and home health services. This plan provides coverage for a wide range of services, including prescription hearing aids, with copays, and vision care, including routine eye exams. You can also expect coverage for medical equipment, diagnostic services, and skilled nursing facilities. While the plan offers many benefits, it is important to note that some services, like additional home health care, and certain dental, vision, and other services may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $410 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a $370 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. 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 Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $400 copay, observation services with a $385 copay, ambulatory surgical center services with a $350 copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the MedMutual Advantage Select (PPO) plan, with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MedMutual Advantage Select (PPO). Ground ambulance services have a $245 copay, and air ambulance services have a 50% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by MedMutual Advantage Select (PPO), with copays of $110, $45, and $110 respectively, and no coinsurance. Worldwide Urgent Coverage is also covered with a $45 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $40 copay, and Physical Therapy and Speech-Language Pathology Services with a $40 copay. Additional Telehealth Benefits have a copay between $5 and $45, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The MedMutual Advantage Select (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may include a coinsurance, and some services like health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing exams and prescription hearing aids are covered under the MedMutual Advantage Select (PPO) plan. Routine hearing exams are covered once per year, and prescription hearing aids (all types) are covered with a copay between $499 and $999, twice per year.
Vision Services See details
The MedMutual Advantage Select (PPO) plan covers vision services, including routine eye exams once per year. Eyewear has a 20% coinsurance for contact lenses, with a combined maximum benefit of $100 per year, and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Select (PPO) plan covers Medicare Dental Services with a $45 copay, as well as Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment. However, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Select (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 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 $150 and $225, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All of these services require prior authorization.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Select (PPO) plan with no copay or 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 covered by the MedMutual Advantage Select (PPO) plan, but not the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MedMutual Advantage Select (PPO), 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 for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MedMutual Advantage Select (PPO) plan does not cover acupuncture, 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. Over-the-counter (OTC) items are covered with a maximum benefit of $30 every three months. Other 1 services are covered with a copay between $0 and $410, and a coinsurance between 0% and 50%.
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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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