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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 $193.00. 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 $1500.00 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 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a preferred generic drug has a $5 copay at a preferred pharmacy, while a standard generic drug has a $42 copay. During the initial coverage phase, you'll pay these costs until your total drug costs reach $2000. After reaching $2000 in out-of-pocket drug costs, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The MedMutual Advantage Premium (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You will have no copay for primary care physician services, hearing exams, home health services, and routine eye exams. The plan also covers emergency services, ambulance, and transportation services. This plan provides coverage for preventive services, vision, dental, and hearing. Additional benefits include home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facility services. However, certain services such as cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $365 copay for days 1-6, and no copay for days 7-90; Inpatient Hospital Psychiatric has a $370 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute, as well as non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
The MedMutual Advantage Premium (PPO) plan covers outpatient services, including outpatient hospital services with a $365 copay, observation services with a $390 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services are covered with a $35 copay for individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Premium (PPO) plan with a $35 copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the MedMutual Advantage Premium (PPO) plan. Ground ambulance services have a $245 copay, while air ambulance services have a 50% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, but 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 under the MedMutual Advantage Premium (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $35 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay and no coinsurance. Worldwide Urgent Coverage has a $35 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Premium (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 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 copay between $0 and $35, and opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Weight Management Programs have 70% coinsurance, and Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The MedMutual Advantage Premium (PPO) plan covers hearing exams with no deductible and routine hearing exams once per year, but fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with a copay between $499 and $999 for up to two visits per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The MedMutual Advantage Premium (PPO) plan covers vision services, including routine eye exams with no copay. Eyewear, including contact lenses and eyeglasses, is covered with a 20% coinsurance, with a combined maximum of $250 every year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services under the MedMutual Advantage Premium (PPO) plan include a $35 copay for Medicare Dental Services. Other covered services include Oral Exams with a limit of 2 per year, Dental X-Rays with a limit of 1 per year, Other Diagnostic Dental Services with 30% coinsurance, Prophylaxis (Cleaning) with a limit of 2 per year, and Fluoride Treatment with a limit of 1 per year. Restorative Services, Adjunctive General Services, and Oral and Maxillofacial Surgery are covered with 30% coinsurance, while Endodontics and Periodontics have 50% coinsurance. However, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $2,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Premium (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the MedMutual Advantage Premium (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, Diabetic Supplies with a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services are covered. You may have a copay of up to $10 for diagnostic procedures/tests, no copay for lab services, up to $225 for diagnostic radiological services, and $50 for outpatient X-ray services. Therapeutic radiological services have a coinsurance of at least 20%.
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
The MedMutual Advantage Premium (PPO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214.
Other Services See details
Other services are partially covered by the MedMutual Advantage Premium (PPO) plan. Acupuncture, 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.
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