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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 $11000.00 (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 $11000.00 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'll pay different copays or coinsurance amounts depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies, and preferred mail order has no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MedMutual Advantage Access (PPO) plan offers coverage for a wide range of services with varying costs. Inpatient hospital stays have a copay, while outpatient services, including mental health and substance abuse, have copays ranging from $30 to $395. Emergency services and primary care visits also have copays. Preventive services are covered with no copay, and the plan includes hearing and vision benefits with copays or coinsurance. Dental services are covered with a copay and annual maximum, while other benefits such as ambulance, home health, and skilled nursing facilities are covered with copays or coinsurance. This plan also covers diagnostic and radiological services, medical equipment, and other services with various cost-sharing structures.
Inpatient Hospital See details
The MedMutual Advantage Access (PPO) plan covers inpatient hospital stays with a copay of $370 for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute are covered, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered. Inpatient hospital psychiatric benefits are covered with a copay of $370 for days 1-5, and no copay for days 6-90, but additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the MedMutual Advantage Access (PPO) plan. Outpatient Hospital Services have a $345 copay, Observation Services have a $395 copay, Ambulatory Surgical Center (ASC) Services have a $300 copay, and Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Access (PPO) plan, with a $30 copay.
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 50% coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage has a $40 copay, while 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 $15 copay), Occupational Therapy Services (with a $35 copay), Physician Specialist Services (with a $35 copay), 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 copay between $0 and $35), and Psychiatric Services (with a $30 copay for individual and group sessions). This plan does not cover Podiatry Services.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, an annual physical exam, and additional services like weight management programs with a 70% coinsurance. Some services, such as health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing exams and prescription hearing aids are covered by the MedMutual Advantage Access (PPO) plan; routine hearing exams are covered for one visit every year, and prescription hearing aids have a copay between $499 and $999, depending on the type of aid. 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
Vision services include routine eye exams with no copay, and eyewear with a 20% coinsurance for contact lenses. Eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered. The combined maximum plan benefit coverage amount for eyewear is $100 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and other dental services with a $2,000 annual maximum. Other covered dental services include oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services with 30% coinsurance, prophylaxis (cleaning) (2 visits per year), fluoride treatment (1 visit per year), restorative services with 30% coinsurance, adjunctive general services with 30% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, and oral and maxillofacial surgery with 30% coinsurance. Prosthodontics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Access (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment with coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological 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 up to $175, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Access (PPO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of 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. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under 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 and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the MedMutual Advantage Access (PPO) plan, Other Services includes Over-the-Counter (OTC) items with a maximum benefit coverage amount of $60 every three months, while Acupuncture is not covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are also 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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