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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 2026, 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 4.5 out of 5 stars in 2026.
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 a $300.00 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 $8500.00 (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 $8500.00 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:
Sign up for MedMutual Advantage Access (PPO)
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Drug Coverage
The MedMutual Advantage Access (PPO) plan features a $300 drug deductible. You can expect no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using preferred pharmacies or preferred mail order services. For standard pharmacies and standard mail order, Tier 1 copays range from $6 to $15, and Tier 2 copays range from $8 to $20. Higher-tier prescription drugs under this plan require coinsurance instead of copays. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs require a 40% coinsurance. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply across all pharmacy network types.
Additional Benefits
The MedMutual Advantage Access (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physical exams, and routine preventive screenings. For specialized care and hospital services, members can expect a $40 copay for specialist visits, a $425 daily copay for the first six days of inpatient hospital stays, and a $400 copay for outpatient hospital services. Emergency care is accessible with a $130 copay, which is waived if admitted, while urgent care requires a $40 copay. This plan also includes valuable supplemental benefits like routine vision and hearing exams with no copay, plus up to a $1,000 annual dental allowance with no copay for most preventive and comprehensive services. Additionally, members benefit from a $200 annual eyewear allowance, affordable prescription hearing aids, and up to 24 free one-way transportation trips to plan-approved locations. Other everyday conveniences, including home health services, over-the-counter items, and post-discharge meals, are also covered with no copay or coinsurance.
Inpatient Hospital See details
MedMutual Advantage Access (PPO) covers inpatient acute hospital stays with no coinsurance and a $425 copay for days 1 through 6, and no copay for days 7 through 90 with unlimited additional days. Inpatient psychiatric stays are covered with no coinsurance and require a $370 copay for days 1 through 5, and no copay for days 6 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
MedMutual Advantage Access (PPO) covers outpatient services with no coinsurance, requiring a $400 copay for outpatient hospital services, a $450 copay per stay for observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Access (PPO) with a $40.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
MedMutual Advantage Access (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, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
MedMutual Advantage Access (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no coinsurance and matching copays of $130 and $40 respectively, but worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Access (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy require a $40 copay and no coinsurance. Chiropractic services are only partially covered as routine chiropractic is not covered, and podiatry services are not covered by the plan.
Preventive Services See details
MedMutual Advantage Access (PPO) partially covers preventive services, providing no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings, while weight management programs require a 70% coinsurance. Several supplemental benefits are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, alternative therapies, therapeutic massage, and adult day health services.
Hearing Services See details
MedMutual Advantage Access (PPO) partially covers hearing services, offering one annual routine hearing exam with no copay and no coinsurance, alongside up to two prescription hearing aids per year for a copay of $499 to $999 and no coinsurance. Hearing aid fittings or evaluations, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by MedMutual Advantage Access (PPO), offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay and a $200 annual limit for either one pair of eyeglasses or contact lenses (which require a 20% coinsurance), but individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the MedMutual Advantage Access (PPO) up to an annual maximum of $1,000, excluding other preventive services, maxillofacial prosthetics, and orthodontics. Most covered preventive and comprehensive services require no copay and no coinsurance, though Medicare-covered dental has a $40 copay and no coinsurance, and implants and prosthodontics have no copay and 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the MedMutual Advantage Access (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, insulin, and other infusion drugs require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Access (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by MedMutual Advantage Access (PPO) with no copays, though prior authorization and coinsurance will apply to most items. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes require a 20% coinsurance, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Access (PPO) covers diagnostic and radiological services with prior authorization, featuring a $10 copay and no coinsurance for diagnostic tests, procedures, and lab services. Outpatient X-rays carry a $50 copay, diagnostic radiology requires a minimum $100 copay, and therapeutic radiology incurs a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the MedMutual Advantage Access (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the MedMutual Advantage Access (PPO) plan with no coinsurance, but require prior authorization. While some services are covered, cardiac and intensive cardiac rehabilitation (each requiring a $40 copay), along with pulmonary and supervised exercise therapy (SET) for peripheral artery disease (PAD) services (each requiring a $25 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by MedMutual Advantage Access (PPO) with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by MedMutual Advantage Access (PPO), excluding acupuncture. Covered benefits include over-the-counter items and meals with no copay and no coinsurance, as well as Travel Plus benefits with copays ranging from no copay to $450.00 and coinsurance from no coinsurance 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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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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