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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) plan features a low $55 annual drug deductible and offers excellent savings on generic and select care medications. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at preferred pharmacies or through preferred mail order, as well as no copay for Tier 6 select care drugs across all pharmacy options. Tier 2 generic drugs are also highly affordable, with copays starting as low as $4 for a one-month supply through preferred mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance across all pharmacy options. Specialty medications in Tier 5 are covered with a 32% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The MedMutual Advantage Preferred (PPO) plan offers comprehensive medical coverage featuring no copay for preventive services, annual physical exams, and routine vision and hearing tests. Primary care doctor visits require a low $5 copay, while specialist visits have a $30 copay, both with no coinsurance. For inpatient hospital stays, members pay a daily copay of $365 for acute care or $370 for psychiatric care for the first five days, followed by no copay for days six through 90. Emergency room visits carry a $115 copay, which is waived if admitted, while urgent care services require a $40 copay. The plan also includes preventive dental care, home health services, and up to 24 one-way transportation trips per year to approved locations with no copay. Durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
MedMutual Advantage Preferred (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $365 daily copay for acute stays and a $370 daily copay for psychiatric stays for days 1 through 5, and no copay for days 6 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
MedMutual Advantage Preferred (PPO) covers outpatient services with no coinsurance, featuring a $330 copay for outpatient hospital services, a $395 copay per stay for observation services, and a $350 copay for ambulatory surgical center services. Outpatient substance abuse individual and group sessions require a $30 copay and 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, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MedMutual Advantage Preferred (PPO), featuring a $235 copay and no coinsurance for ground ambulance services, and a 50% coinsurance with no copay for air ambulance services. Transportation is partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
MedMutual Advantage Preferred (PPO) covers emergency services with a $115 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care services under MedMutual Advantage Preferred (PPO) are covered with a $5 copay for primary care doctors and a $30 copay for specialists, with no coinsurance for either. Physical, occupational, and mental health therapies require copays between $30 and $40 with no coinsurance, while chiropractic services are partially covered (excluding routine care) and podiatry is 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 routine screenings. Additional preventive benefits are partially covered, offering select services like memory fitness and smoking cessation with no copay and weight management programs with a 70% coinsurance, while sub-services such as health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by MedMutual Advantage Preferred (PPO), offering one routine hearing exam per year with no copay and no coinsurance, while fitting evaluations and OTC hearing aids are not covered. Prescription hearing aids are covered up to two times per year with no coinsurance and a copay between $499.00 and $999.00, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Vision services are partially covered by the MedMutual Advantage Preferred (PPO), offering one routine eye exam per year with no copay or coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay and a combined $200 annual limit for either one pair of contact lenses (subject to a 20% coinsurance) or one pair of eyeglasses, while individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MedMutual Advantage Preferred (PPO), offering Medicare-covered dental care for a $30 copay and no coinsurance, as well as preventive services like exams, cleanings, x-rays, and fluoride treatments for no copay and no coinsurance. However, other preventive dental, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
MedMutual Advantage Preferred (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy may apply. Covered Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Medicare Part B insulin drugs are subject to a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by MedMutual Advantage Preferred (PPO) 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 copayments. Beneficiaries will pay a 20% coinsurance for most equipment and devices, while diabetic supplies carry a coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by MedMutual Advantage Preferred (PPO) with no coinsurance and a $10 copay for lab services and diagnostic procedures. Outpatient x-rays require a $50 copay, while diagnostic radiological services have a minimum $100 copay and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the MedMutual Advantage Preferred (PPO) plan 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, subject to prior authorization, while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MedMutual Advantage Preferred (PPO) 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 limit are not covered.
Other Services See details
MedMutual Advantage Preferred (PPO) partially covers other services, offering a meal benefit with no copay and no coinsurance, and Travel Plus coverage with copays ranging from no copay to $395.00 and coinsurance from no coinsurance to 50% up to a $7,500 annual limit. Acupuncture and over-the-counter (OTC) items are not covered, and prior authorization is required for the covered services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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