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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 significant savings on generic medications. You will pay no copay for Tier 1 preferred generics filled at preferred pharmacies or through preferred mail order, as well as no copay for Tier 6 select care drugs at any pharmacy. Tier 2 generic drugs are also highly affordable, with copays starting at just $4 for a one-month supply via preferred mail order or $5 at preferred pharmacies. For higher-tier medications, costs are determined by coinsurance rather than flat copays. You will pay a 23% coinsurance for Tier 3 preferred brands and a 43% coinsurance for Tier 4 non-preferred drugs across all pharmacy and mail-order options. Specialty medications in Tier 5 carry a 31% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The MedMutual Advantage Select (PPO) plan offers affordable access to essential medical services, featuring a low $5 copay for primary care visits and a $30 copay for specialists with no coinsurance. For hospital stays, members pay a daily copay of $395 for days one through five of acute inpatient care, while home health services and the first 20 days in a skilled nursing facility require no copay. Emergency care is available with a $115 copay, and urgent care visits cost $40, with no coinsurance for either service. This plan also includes key supplemental benefits, providing routine dental, vision, and hearing exams with no copay or coinsurance. Members can access prescription hearing aids for a copay ranging from $499 to $999, alongside a $100 annual allowance for eyewear and up to 24 one-way transportation trips to approved locations with no copay. Additionally, over-the-counter items and a post-discharge meal benefit are covered with no copay or coinsurance.
Inpatient Hospital See details
MedMutual Advantage Select (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $395 daily copay for days 1 to 5 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MedMutual Advantage Select (PPO) with no coinsurance, featuring a $360 copay for outpatient hospital and observation services and a $380 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Select (PPO) with a $30.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
MedMutual Advantage Select (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
MedMutual Advantage Select (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with no coinsurance, requiring a $115 copay for emergency care and a $40 copay for urgent care, while 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. Therapy and mental health services are also covered with copays ranging from $30 to $40 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
MedMutual Advantage Select (PPO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are only partially covered, with weight management requiring a 70% coinsurance, while services like health education, personal emergency response systems, in-home safety assessments, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by MedMutual Advantage Select (PPO), featuring routine hearing exams with no copay and no coinsurance, and prescription hearing aids with no coinsurance and a copay ranging from $499 to $999. Fitting and evaluation services, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by MedMutual Advantage Select (PPO), featuring one routine eye exam per year with no copay, no coinsurance, and no deductible. Eyewear is covered up to a $100 annual maximum with no copay and a 20% coinsurance on contact lenses, though other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
MedMutual Advantage Select (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $30 copay and no coinsurance, alongside routine preventive services like exams, cleanings, x-rays, and fluoride treatments with no copay and no coinsurance. However, other preventive services, restorative care, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
MedMutual Advantage Select (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
MedMutual Advantage Select (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the MedMutual Advantage Select (PPO) with no copay for all categories, though prior authorization is required for durable medical equipment and prosthetics. You will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies carry a coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
MedMutual Advantage Select (PPO) covers diagnostic and radiological services, with prior authorization required for all care. Diagnostic tests, procedures, and lab services require a $10 copay and no coinsurance, while outpatient x-rays cost a $50 copay and coinsurance, diagnostic radiology has a minimum $100 copay, and therapeutic radiology requires a minimum 20% coinsurance and a copay.
Home Health Services See details
MedMutual Advantage Select (PPO) offers full coverage for home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the MedMutual Advantage Select (PPO) plan with no coinsurance and require prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
MedMutual Advantage Select (PPO) offers other services featuring a meal benefit and over-the-counter (OTC) items with no copay or coinsurance, while acupuncture is not covered. Additionally, the MedMutual Advantage Travel Plus benefit is covered with copays ranging from $0 to $410 and 0% to 50% coinsurance, subject to prior authorization.
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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.
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