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MedMutual Advantage Premium (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Premium (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Premium (PPO) in 2025, please refer to our full plan details page.
MedMutual Advantage Premium (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 Premium (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 Premium (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 Premium (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $127.00. 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 $1250.00 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 $5150.00 (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 $5150.00 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 Premium (PPO) plan has a $55.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you'll pay a $5.00 copay at a preferred pharmacy, $12.00 at a standard pharmacy, $4.00 through preferred mail order, or $11.00 through standard mail order. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MedMutual Advantage Premium (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. The plan also covers primary care, preventive services, hearing, vision, and dental services, with specific copays, coinsurance, and limitations on coverage. Additional benefits include ambulance and transportation services, emergency services, home health services, and skilled nursing facility services. This plan provides coverage for home infusion services, dialysis, and medical equipment, with associated copays and coinsurance. Other services include coverage for OTC items, and a meal benefit. However, it's important to note that certain services like cardiac rehabilitation, and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $325 copay, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $300 copay, and Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Premium (PPO) plan, with a $30 copay.
Ambulance and Transportation Services See details
The MedMutual Advantage Premium (PPO) plan covers ambulance and transportation services. 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, while transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the MedMutual Advantage Premium (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage has a $30 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Premium (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$30 copay, and psychiatric services with a $30 copay for individual and group sessions, as well as opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered by the MedMutual Advantage Premium (PPO) plan. Additional preventive services may have a coinsurance, while services such as health education, in-home safety assessments, and counseling services are not covered. Weight Management Programs have a 70% coinsurance.
Hearing Services See details
The MedMutual Advantage Premium (PPO) plan covers hearing exams and prescription hearing aids, with routine hearing exams covered for 1 visit per year. Prescription hearing aids have a copay between $499 and $999 for up to 2 visits per year, while 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 Premium (PPO) plan's vision services cover routine eye exams once per year with no copay or coinsurance. Eyewear, including contact lenses and eyeglasses, is partially covered, with a 20% coinsurance for contact lenses, and a combined maximum of $250 per year for all eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Premium (PPO) plan covers dental services, including Medicare dental services with a $30 copay, and other dental services with a $2,000 annual maximum. Oral exams are covered for 2 visits per year, and dental x-rays are covered for 1 per year; other diagnostic services, restorative services, adjunctive general services, and oral and maxillofacial surgery have a 30% coinsurance, while endodontics and periodontics have a 50% coinsurance. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Premium (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered under the MedMutual Advantage Premium (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $100, and at most $175. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Premium (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 not covered by the MedMutual Advantage Premium (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 Premium (PPO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The MedMutual Advantage Premium (PPO) plan's Other Services benefit covers Over-the-Counter (OTC) Items, with a maximum benefit of $45 every three months. The plan also covers a Meal Benefit for a chronic illness, and "Other 1" services with a copay between $0 and $400, and coinsurance between 0% and 50%. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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.
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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.
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.
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