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MedMutual Advantage Preferred (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Preferred (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Preferred (PPO) in 2026, please refer to our full plan details page.
MedMutual Advantage Preferred (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 Preferred (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 Preferred (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 Preferred (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 $1750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $55.00 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 $10100.00 (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 $10100.00 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 Preferred (PPO) Medicare plan features a low annual drug deductible of $55. Under this plan, you will pay no copay for Tier 6 select care drugs across all pharmacies, and no copay for Tier 1 preferred generics at preferred pharmacies and preferred mail order. Other generic medications under Tier 2 carry low copays starting at $4 for a one-month supply depending on the pharmacy you choose. For brand-name and specialty medications, cost-sharing is based on coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, and Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty drugs in Tier 5 require a 32% coinsurance for a one-month supply at all standard and preferred pharmacy locations.
Additional Benefits
The MedMutual Advantage Preferred (PPO) plan offers comprehensive medical coverage with affordable out-of-pocket costs, 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 $325 for acute inpatient days 1 to 5, followed by no copay for days 6 through 90. Emergency room visits require a $115 copay, which is waived if admitted, while urgently needed services have a $40 copay. This plan also highlights exceptional value on routine care, providing preventive services, annual routine eye and hearing exams, and dental cleanings with no copay and no coinsurance. Additional perks include up to 24 free one-way transportation trips per year, home health services with no copay, and a $200 annual allowance for glasses or contacts. For prescription hearing aids, members pay no coinsurance and a copay ranging from $499 to $999.
Inpatient Hospital See details
MedMutual Advantage Preferred (PPO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $325 for days 1 to 5 for acute stays and $350 for days 1 to 5 for psychiatric stays, followed by no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
MedMutual Advantage Preferred (PPO) covers outpatient services with no coinsurance, featuring a $315 copay for outpatient hospital services and a $350 copay for ambulatory surgical center and observation services. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Preferred (PPO) with a $30.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
MedMutual Advantage Preferred (PPO) covers ground ambulance services with a $230 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by MedMutual Advantage Preferred (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 lifetime maximum with a $115 copay for emergency care, a $40 copay for urgent care, and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Preferred (PPO) partially covers primary care benefits, offering primary care visits for a $5 copay and specialist visits for a $30 copay with no coinsurance. Covered therapy, psychiatric, and telehealth services have copays ranging from $5 to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by MedMutual Advantage Preferred (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings like glaucoma and diabetes self-management. Additional preventive benefits are partially covered, including memory fitness and weight management programs with a 70% coinsurance, while services like health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
MedMutual Advantage Preferred (PPO) partially covers hearing services, offering one annual routine hearing exam with no copay or coinsurance, and up to two prescription hearing aids per year with no coinsurance and a copay ranging from $499 to $999. Fitting and evaluation exams, over-the-counter hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
MedMutual Advantage Preferred (PPO) offers partially covered vision services with no deductibles, including one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay, a 20% coinsurance for contact lenses, and a $200 annual limit for one pair of glasses or contacts, while individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the MedMutual Advantage Preferred (PPO) plan, featuring preventive care such as cleanings, exams, x-rays, and fluoride treatments with no copay and no coinsurance, and Medicare-covered dental services for a $30 copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MedMutual Advantage Preferred (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
MedMutual Advantage Preferred (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Preferred (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for all covered items. A 20% coinsurance applies to most equipment and supplies, though diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by MedMutual Advantage Preferred (PPO), with prior authorization required. Diagnostic tests, procedures, and lab services require a $10 copay and no coinsurance, while outpatient X-rays have a $50 copay, diagnostic radiological services require a minimum $100 copay, and therapeutic radiological services have a minimum 20% coinsurance.
Home Health Services See details
MedMutual Advantage Preferred (PPO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MedMutual Advantage Preferred (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance, though standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Preferred (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the MedMutual Advantage Preferred (PPO) plan, with acupuncture and over-the-counter (OTC) items not covered. Covered benefits include a chronic illness meal benefit with no copay and no coinsurance, and the MedMutual Advantage Travel Plus benefit, which features a $7,500 annual limit with a copay ranging from no copay to $350 and coinsurance ranging from no coinsurance to 50% (prior authorization is required for both).
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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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