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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 $49.00. 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 deductible. During 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, preferred generic drugs have a $5 copay at preferred pharmacies, while preferred brand drugs have a 50% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs.
Additional Benefits
The MedMutual Advantage Select (PPO) plan offers coverage for a wide range of services, including inpatient hospital stays with a copay, outpatient services, and emergency care. Primary care visits have a $5 copay, and specialist visits have a $35 copay. The plan also covers hearing and vision services, with routine exams and hearing aids, and eyewear. Additional benefits include dental services, home infusion, and dialysis. The plan also covers ambulance services, offers transportation for health-related needs, and covers some medical equipment. Diagnostic and radiological services have varying copays and coinsurance amounts. Other covered services include home health services and skilled nursing facility stays.
Inpatient Hospital See details
The MedMutual Advantage Select (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $410 for days 1-5 and no copay for days 6-90. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $370 for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $360 copay, Observation Services with a $360 copay, Ambulatory Surgical Center (ASC) Services with a $350 copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $40 and $40, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Select (PPO) plan, 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 up to 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, and Worldwide Emergency Coverage are covered under the MedMutual Advantage Select (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Select (PPO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $35 copay, while physician specialist services have a $35 copay. Mental health and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits range from a $5 to $35 copay, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services are covered; 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Weight Management Programs have a 70% coinsurance, while Smoking Cessation Counseling is covered for up to 6 sessions, and the Fitness Benefit includes Memory Fitness.
Hearing Services See details
Hearing services include routine hearing exams, covered once per year, and prescription hearing aids, covered twice per year with a copay between $499 and $999. Fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, over-the-ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The MedMutual Advantage Select (PPO) plan covers routine eye exams once per year, and eyewear including contact lenses, with a 20% coinsurance for contact lenses, and a combined maximum of $100 per year for eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Select (PPO) plan covers a $35 copay for Medicare dental services. Other dental services are covered, including oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatments (1 per year). 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, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B drugs, and Medicare Part B Chemotherapy/Radiation Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Select (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by MedMutual Advantage Select (PPO), including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Supplies with 0-20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Therapeutic Shoes/Inserts are covered with 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, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $175, 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 by MedMutual Advantage Select (PPO) with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MedMutual Advantage Select (PPO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Select (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the "Other Services" benefit, 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 are not covered. Over-the-counter (OTC) items are covered with a maximum benefit of $40.00 every three months, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as an OTC benefit. Other 1 has a coinsurance of 0% to 50% and a copay of $0.00 to $410.00, and covers MedMutual Advantage Travel Plus with a maximum amount of $7500.00 every year.
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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.
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