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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 $129.00. 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 $55.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay $5.00 for preferred generic drugs at a preferred pharmacy, and 50% coinsurance for preferred brand drugs. 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 comprehensive coverage with a variety of benefits. It includes coverage for inpatient and outpatient services, with varying copays depending on the service. The plan also provides coverage for primary care, preventive services, and specialized services such as hearing, vision, and dental, with specific copays and coinsurance for each. Additionally, the plan offers coverage for ambulance and transportation services, emergency services, and home health services. Other notable benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities. This plan also has an "other services" benefit that provides coverage for over-the-counter items and other services with varying costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you 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 $345 copay, observation services with a $400 copay, ambulatory surgical center 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 by the MedMutual Advantage Premium (PPO) plan with a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MedMutual Advantage Premium (PPO) plan. Ground ambulance services have a $200 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 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 and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $30 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Premium (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, physician specialist services have a $30 copay, occupational therapy services have a $45 copay, physical therapy and speech-language pathology services have a $40 copay, and individual and group mental health and psychiatric sessions have a $30 copay. Other Health Care Professional services have a copay between $0 and $45, and telehealth benefits have a copay between $0 and $30. Routine chiropractic care is not covered, and there is a 20% coinsurance for Opioid Treatment Program Services.
Preventive Services See details
Preventive services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered by MedMutual Advantage Premium (PPO). Some 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 routine hearing exams once per year, and prescription hearing aids, with a copay between $499 and $999 depending on the type of hearing aid. 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 includes routine eye exams with no copay, and eyewear with a 20% coinsurance for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Premium (PPO) plan covers Medicare dental services with a $30 copay, and other dental services up to a $2,000 annual maximum. This plan covers oral exams (2 per year) and dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatments (1 per year). Other diagnostic dental services, restorative services, adjunctive general services, and oral and maxillofacial surgery are covered with 30% coinsurance, while endodontics and periodontics have 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 by the MedMutual Advantage Premium (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by MedMutual Advantage Premium (PPO) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts, all with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services are covered. Diagnostic procedures/tests have a copay between $0 and $10, while lab services have no copay. Diagnostic Radiological Services have a copay between $100 and $175, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Premium (PPO) plan with no copay and no coinsurance; however, 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 MedMutual Advantage Premium (PPO). Prior authorization is required for these services, but all of the sub-services are not covered.
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, there is a $20 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF, 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 coverage of $40 every three months, and includes nicotine replacement therapy and Naloxone coverage. 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. Other 1 services are covered with a coinsurance between 0% and 50% and a copay between $0 and $400, and a maximum coverage amount of $7500 per year.
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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.
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