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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 2026, 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 4.5 out of 5 stars in 2026.
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 $149.00. 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) Medicare plan features a low annual drug deductible of $55. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when utilizing preferred pharmacies or preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $4 copay for a one-month supply through preferred mail order. Brand-name and specialty medications on this plan require coinsurance instead of flat copayments. You will pay a 23% coinsurance for Tier 3 preferred brands and a 43% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 32% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The MedMutual Advantage Premium (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, annual physicals, and routine preventive services. For specialized medical care, beneficiaries pay a $30 copay for specialist visits and a $335 daily copay for the first five days of an acute inpatient hospital stay. Outpatient hospital services and ambulatory surgical center visits require copays ranging from $300 to $400, while home health services are fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay and no coinsurance. Beneficiaries receive up to a $2,000 annual maximum for dental care and a $250 annual allowance for eyewear, though certain services like hearing aids and advanced dental care require copays or coinsurance. Additionally, emergency care is covered with a $150 copay, and the plan provides up to 24 one-way transportation trips per year to approved health locations with no copay and no coinsurance.
Inpatient Hospital See details
MedMutual Advantage Premium (PPO) covers inpatient hospital services with no coinsurance, requiring a $335 daily copay for days 1-5 of acute stays and a $370 daily copay for days 1-5 of psychiatric stays, with no copays for subsequent Medicare-covered days. Prior authorization is required, and non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
MedMutual Advantage Premium (PPO) covers outpatient services with no coinsurance, featuring a $325 copay for outpatient hospital services, a $400 copay per stay for observation services, and a $300 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $30 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the MedMutual Advantage Premium (PPO) plan with a $30.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
MedMutual Advantage Premium (PPO) covers ground ambulance services with a $235 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered under the plan, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
MedMutual Advantage Premium (PPO) covers emergency services with a $150 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $150 copay for emergency care, a $30 copay for urgent care, and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Premium (PPO) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapy require a $40 to $45 copay and no coinsurance, mental health services have a $30 copay and no coinsurance, and podiatry is not covered. For chiropractic care, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by MedMutual Advantage Premium (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other preventive screenings. Additional preventive services are partially covered with no copay and no coinsurance, except for weight management programs which require a 70% coinsurance; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by MedMutual Advantage Premium (PPO), featuring one annual routine hearing exam with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with a $499 to $999 copay and no coinsurance, while fitting evaluations, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
MedMutual Advantage Premium (PPO) offers partially covered vision services, including one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay and a 20% coinsurance for contact lenses, providing a $250 combined annual limit for either one pair of contact lenses or eyeglasses, while separate lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the MedMutual Advantage Premium (PPO) up to a $2,000 annual maximum, with no copay and no coinsurance for preventive care, and a $30 copay with no coinsurance for Medicare-covered dental. Other covered services have no copay and a 30% to 50% coinsurance, but other preventive services, implants, orthodontics, prosthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
MedMutual Advantage Premium (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the MedMutual Advantage Premium (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Premium (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay required. Beneficiaries will pay a 20% coinsurance for DME, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Premium (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and lab services feature a $10 copay and no coinsurance, while outpatient X-rays require a $50 copay, diagnostic radiology has a $100 minimum copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the MedMutual Advantage Premium (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the MedMutual Advantage Premium (PPO) with no coinsurance and required prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require copays ranging from $25 to $45.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MedMutual Advantage Premium (PPO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
MedMutual Advantage Premium (PPO) covers over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, though acupuncture is not covered. The plan also offers MedMutual Advantage Travel Plus with a copay ranging from $0.00 to $400.00 and 0% to 50% coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
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