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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 $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) prescription drug plan features a low annual drug deductible of $55. 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 at any pharmacy. Tier 2 generic drug copays are also budget-friendly, starting at just $4 for a one-month supply through preferred mail order. For brand-name and specialty medications, your costs are based on a percentage of the drug cost. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs carry a 43% coinsurance. Tier 5 specialty drugs are covered with a 32% coinsurance for a one-month supply across all network pharmacy and mail order options.
Additional Benefits
The MedMutual Advantage Premium (PPO) plan offers comprehensive healthcare coverage with no copays for primary care visits, preventive services, or home health care. Specialist office visits require a $30 copay, while inpatient hospital stays have a daily copay of $335 for days 1 to 6 with no coinsurance. Outpatient hospital services feature a $345 copay, and emergency services are covered with a $150 copay that is waived if you are admitted. Supplemental benefits include routine dental, vision, and hearing exams with no copays. Dental services are covered up to a $2,000 annual limit with coinsurance ranging from 0% to 50%, while prescription hearing aids require a copay between $499 and $999. Additionally, the plan covers up to 24 one-way transportation trips per year with no copay, and durable medical equipment requires a 20% coinsurance with no copay.
Inpatient Hospital See details
MedMutual Advantage Premium (PPO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $335 for days 1 to 6 of acute stays and $370 for days 1 to 5 of psychiatric stays, followed by no copay for remaining days. Non-Medicare-covered stays, acute upgrades, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by MedMutual Advantage Premium (PPO) with no coinsurance, featuring a $345 copay for outpatient hospital services, a $400 copay per stay for observation services, and a $300 copay for ambulatory surgical center services. Individual and group outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
MedMutual Advantage Premium (PPO) covers partial hospitalization services with a $30.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
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. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, 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 within 24 hours) and urgently needed services with a $30 copay, both featuring no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit with a $150 copay for emergency care and a $30 copay for urgent care (with no coinsurance for either), though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Premium (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Additional services like physical therapy ($40 copay), occupational therapy ($45 copay), and mental health sessions ($30 copay) carry no coinsurance, though podiatry is not covered, chiropractic care is only partially covered, and opioid treatment has no copay with a 20% coinsurance.
Preventive Services See details
MedMutual Advantage Premium (PPO) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay, although weight management programs require a 70% coinsurance, and services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
MedMutual Advantage Premium (PPO) covers routine hearing exams with no copay and no coinsurance, but hearing aid fittings, evaluations, and OTC hearing aids are not covered. Prescription hearing aids are partially covered with no coinsurance and a copay between $499 and $999 for up to two aids per year, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
MedMutual Advantage Premium (PPO) offers partially covered vision services with no deductibles, featuring one annual routine eye exam with no copay and no coinsurance, and eyewear with no copay and a 20% coinsurance for contact lenses up to a $250 yearly limit. This benefit is partially covered because other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered, and members must choose between one pair of eyeglasses or contact lenses per year.
Dental Services See details
MedMutual Advantage Premium (PPO) dental services are partially covered up to a $2,000 annual limit, offering preventive care and select comprehensive services with no copay and coinsurance ranging from 0% to 50%, while Medicare-covered dental requires a $30 copay and no coinsurance. Other preventive services, removable and fixed prosthodontics, implants, maxillofacial prosthetics, and orthodontics 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. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Premium (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the MedMutual Advantage Premium (PPO) with no copays, though coinsurance fees apply to most items. You will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while other diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Premium (PPO) covers diagnostic and radiological services, subject to prior authorization. Diagnostic procedures, tests, and lab services require a $10 copay and no coinsurance, while radiological services require a $100 copay for diagnostic radiology, a $50 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by MedMutual Advantage Premium (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by MedMutual Advantage Premium (PPO) with no coinsurance and require prior authorization. While some services are covered, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($30 copay), and SET for PAD services ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Premium (PPO) partially covers skilled nursing facility (SNF) services with no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. Covered services require a daily copay of $20 for days 1 to 20 and $218 for days 21 to 100, with prior authorization required but no prior three-day hospital stay needed.
Other Services See details
MedMutual Advantage Premium (PPO) provides coverage for select other services, including over-the-counter items and chronic illness meals with no copay and no coinsurance, while acupuncture is not covered. The plan also covers the MedMutual Advantage Travel Plus benefit with a copay ranging from $0 to $400 and coinsurance from 0% to 50%.
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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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.
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