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MedMutual Advantage Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Access (PPO) in 2025, please refer to our full plan details page.
MedMutual Advantage Access (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 Access (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 Access (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 Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7990.00 (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 $7990.00 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 Access (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have an $8 copay at a preferred pharmacy and no copay if using preferred mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MedMutual Advantage Access (PPO) plan offers coverage for a wide range of services, including inpatient and outpatient care, with varying copays depending on the specific service. Emergency services have a copay of $110, while primary care visits have copays ranging from $0 to $45, depending on the type of service. The plan also includes coverage for preventive, hearing, vision, and dental services, along with home health and skilled nursing facility care, with additional benefits for medical equipment, diagnostic services, and transportation. This plan also offers additional benefits such as coverage for OTC items, and a meal benefit. However, some services like cardiac rehabilitation, additional hours of care, and certain dental and vision services may not be covered, or have limitations. The plan also offers coverage for ambulance, transportation, and partial hospitalization, with some services requiring prior authorization.
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 $330 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a $340 copay, observation services have a $395 copay, ambulatory surgical center services have a $300 copay, and outpatient substance abuse individual and group sessions have a $30 copay. Outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Access (PPO) plan, with a copay of $30.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $200 copay, and 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, with no cost sharing.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered with a copay of $110, $40, and $110, respectively, and no coinsurance. Worldwide Urgent Coverage is covered with a copay of $40 and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Access (PPO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy (with a $45 copay), and physician specialist services (with a $30 copay). The plan also covers mental health specialty services (with a $30 copay for individual and group sessions), 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). Opioid Treatment Program Services are covered with 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The MedMutual Advantage Access (PPO) plan covers preventive services, including annual physical exams with no copay. Some additional preventive services are covered, including Weight Management Programs with a 70% coinsurance. Other services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
The MedMutual Advantage Access (PPO) plan covers hearing exams and prescription hearing aids, with the hearing exams including one routine exam per year. Prescription hearing aids have a copay between $499 and $999 for hearing aids of all types. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The MedMutual Advantage Access (PPO) plan covers vision services including eye exams and eyewear. Eyewear has a 20% coinsurance for contact lenses, and a combined maximum benefit of $250 per year for both in-network and out-of-network services; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $30 copay for Medicare dental services. Other dental services are covered with a maximum benefit of $3200 per year, and some services like Prosthodontics, removable, Implant Services, and Prosthodontics, fixed have a 50% coinsurance. Oral exams are limited to 2 visits per year, and Dental X-rays are limited to 1 per year, while Fluoride treatment is limited to 1 per year. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the MedMutual Advantage Access (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Access (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
The MedMutual Advantage Access (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $10, and lab services with no copay. Diagnostic radiological services have a copay between $100 and $175, therapeutic radiological services have a coinsurance of 20% at a minimum, and outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Access (PPO) plan, with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MedMutual Advantage Access (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 Access (PPO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The MedMutual Advantage Access (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $80 every three months, and a Meal Benefit that requires prior authorization. Other services, including acupuncture, are not covered.
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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.
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