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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:
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Drug Coverage
The MedMutual Advantage Access (PPO) prescription drug plan features a $300 annual deductible. You can save on medication costs with no copay for Tier 1 preferred generic and Tier 2 generic drugs when using preferred pharmacies or preferred mail-order services. Additionally, Tier 6 select care drugs are covered with no copay at both standard and preferred pharmacy locations. For higher-tier medications, costs are based on a percentage of the drug's price rather than a flat copayment. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs have a 40% coinsurance. Specialty medications in Tier 5 carry a 29% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The MedMutual Advantage Access (PPO) plan provides comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits, urgent care, and outpatient therapies require a $40 copay, while emergency room visits carry a $130 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay for the first several days and no copay for subsequent days. This plan also features valuable everyday benefits, including routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and hearing aids. Members can access up to 24 one-way trips to plan-approved locations and receive over-the-counter items with no copay or coinsurance. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
MedMutual Advantage Access (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $425 copay for days 1 to 6 and no copay for day 7 and beyond, while psychiatric stays require a $370 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
MedMutual Advantage Access (PPO) covers outpatient services with no coinsurance, though copays vary depending on the specific service. You will pay a $435 copay for outpatient hospital services, a $450 copay per stay for observation services, a $300 copay for ambulatory surgical center services, and a $40 copay for outpatient substance abuse sessions, while outpatient blood services have no copay or deductible.
Partial Hospitalization See details
MedMutual Advantage Access (PPO) covers partial hospitalization services with a $40 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MedMutual Advantage Access (PPO), featuring a $235 copay and no coinsurance for ground ambulance services, and a 50% coinsurance with no copay for air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under MedMutual Advantage Access (PPO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are partially covered up to a $50,000 maximum with no coinsurance, as 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 require a $40 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies are covered with copays ranging from $40 to $45 and no coinsurance, but podiatry is not covered and chiropractic services are only partially covered with routine care excluded.
Preventive Services See details
Preventive services under the MedMutual Advantage Access (PPO) plan generally feature no copay and no coinsurance, including for annual physical exams, kidney disease education, and routine screenings. However, additional preventive benefits are only partially covered: weight management programs require 70% coinsurance, while health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
MedMutual Advantage Access (PPO) offers partially covered hearing services, which include one routine hearing exam per year with no copay, no coinsurance, and no deductible. Up to two prescription hearing aids are covered yearly with no coinsurance and a copay ranging from $499 to $999, but hearing aid fittings, OTC hearing aids, and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
MedMutual Advantage Access (PPO) offers partially covered vision services, including one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $200 annual limit with no copay, allowing for either one pair of contact lenses (subject to a 20% coinsurance) or one pair of eyeglasses per year, while individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MedMutual Advantage Access (PPO), which offers up to a $1,000 annual maximum benefit for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while most preventive and comprehensive services feature no copay and no coinsurance. Implants and prosthodontics require a 50% coinsurance and no copay, while other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the MedMutual Advantage Access (PPO) plan with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by MedMutual Advantage Access (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Access (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copays across all categories. Members will pay a 20% coinsurance for DME, prosthetics, medical supplies, and diabetic shoes, 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 required. Outpatient diagnostic tests, procedures, and lab services require a $10 copay and no coinsurance, while outpatient X-rays carry a $50 copay, diagnostic radiological services have a minimum $100 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
MedMutual Advantage Access (PPO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by MedMutual Advantage Access (PPO) with no coinsurance and prior authorization required, though in practice some services are covered as cardiac and intensive cardiac rehabilitation (each requiring a $40 copay), and pulmonary and SET for 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 required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
MedMutual Advantage Access (PPO) covers other services including over-the-counter items and chronic illness meals with no copay and no coinsurance, though acupuncture is not covered. The plan also covers MedMutual Advantage Travel Plus with a copay ranging from no copay to $450 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.
* 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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