A non-government entity
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 2025, 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 out of 5 stars in 2025.
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 $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:
Sign up for MedMutual Advantage Preferred (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MedMutual Advantage Preferred (PPO) plan has an enhanced alternative drug benefit. The plan has a $55 deductible. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, for a preferred generic drug, you will pay a $5 copay at a preferred pharmacy, and a $12 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The MedMutual Advantage Preferred (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency and urgent care services have copays, and ambulance services are covered with a copay for ground transport and coinsurance for air transport. Primary care visits have a low copay, and the plan also covers specialist visits, mental health services, and various therapies with copays. Preventive services, routine eye exams, and some dental services are covered, with specific copays or coinsurance for services like hearing aids, eyewear, and dental cleanings. Home health, skilled nursing facility, and dialysis services are covered with no or low copays. The plan also includes coverage for durable medical equipment, diagnostic services, and other services like OTC items and meal benefits, with varying cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, the copay is $365 for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, the copay is $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, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $360 copay, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) 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.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MedMutual Advantage Preferred (PPO) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 50% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the MedMutual Advantage Preferred (PPO) plan. For Emergency Services, you will pay a $110 copay, and for Urgently Needed Services, you will pay a $40 copay; there is no coinsurance for either service. Worldwide Emergency Coverage has a $110 copay, and Worldwide Urgent Coverage has a $40 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Preferred (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $30 copay. Mental health services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a copay between $5 and $30. Opioid treatment program services are covered with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Weight Management Programs have a 70% coinsurance, while other services like Health Education, In-Home Safety Assessment, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams and prescription hearing aids. Routine hearing exams are covered for one visit every year, and prescription hearing aids are covered with a copay between $499 and $999 for two visits every year; fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams with no copay, and eyewear, which has a 20% coinsurance for contact lenses. Eyeglasses (lenses and frames) are covered, and you can receive contacts or glasses in lieu of each other, but not both in one year, up to a combined maximum of $200. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with a $40 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) with a $40 copay, and fluoride treatment. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the MedMutual Advantage Preferred (PPO) plan and require prior authorization. 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 under the MedMutual Advantage Preferred (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $10, Lab Services with no copay, Diagnostic Radiological Services with a copay between $100 and $175, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Preferred (PPO) plan with no copay and no 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, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and copay information is available, but not specified in this snippet.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MedMutual Advantage Preferred (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
Other Services includes coverage for Over-the-Counter (OTC) Items, Meal Benefit, and Other 1. Acupuncture is not covered, and the plan offers OTC items, including Nicotine Replacement Therapy (NRT), but does not cover Naloxone. The Meal Benefit requires prior authorization, and Other 1 has a coinsurance of 0% - 50% and a copay of $0 - $395. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved