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Paramount Elite Preferred (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Paramount Elite Preferred (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Paramount Elite Preferred (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Paramount Elite Preferred (PPO) is a PPO plan offered by Paramount Insurance Company available for the 2026 plan year to people living in Greater Toledo OH and select SE MI counties. CMS star rating not available for 2026.
It's important to know that Paramount Elite Preferred (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 Paramount Elite Preferred (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 Paramount Elite Preferred (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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5300.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5300.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8800.00 for out-of-network covered services, the plan will pay 100% of out-of-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8800.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8800.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Paramount Elite Preferred (PPO) Medicare plan features an annual drug deductible of $300. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs for both 1-month and 3-month supplies filled at standard pharmacies or through standard mail order. For higher-tier medications, cost-sharing is structured as coinsurance for standard pharmacy and mail order fills. You will pay a 21% coinsurance for Tier 3 preferred brands, a 41% coinsurance for Tier 4 non-preferred drugs, and a 29% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Paramount Elite Preferred (PPO) plan offers robust medical coverage with no deductible for key services like hearing and vision, and no copays or coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay predictable copayments with no coinsurance, such as $35 for specialist visits and $15 for physical therapy. Inpatient hospital stays and emergency services are also covered with no coinsurance, requiring a $400 copay for days 1 through 5 of acute stays and a $130 copay for emergency visits. This plan also features comprehensive supplemental benefits, including dental care with no copay and no coinsurance up to a $4,000 annual maximum. Vision and hearing services are highly affordable, offering routine exams with no copay, up to a $200 annual eyewear allowance, and prescription hearing aids with copays ranging from $499 to $999. Additionally, members can take advantage of a $75 quarterly over-the-counter allowance and covered home health services with zero out-of-pocket costs.
Inpatient Hospital See details
Paramount Elite Preferred (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1 through 5 of acute stays and a $295 copay for days 1 through 5 of psychiatric stays, with no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Paramount Elite Preferred (PPO) covers outpatient services with no coinsurance, featuring copays of $0 to $375 for outpatient hospital services, $360 per stay for observation services, and $40 for outpatient substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Paramount Elite Preferred (PPO) plan with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Paramount Elite Preferred (PPO), featuring a $295 copay and no coinsurance for both ground and air ambulance services. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Paramount Elite Preferred (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $35 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
Paramount Elite Preferred (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits and mental health sessions require a $35 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $15 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by the Paramount Elite Preferred (PPO) with no coinsurance and no copay for most benefits, excluding a remote access technology copay of up to $30. Uncovered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Paramount Elite Preferred (PPO) with no deductible, including medicare-covered, routine, and fitting exams with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499.00 to $999.00 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Paramount Elite Preferred (PPO), offering covered eye exams with a copay of $0 to $30 and covered eyewear with no copay, both with no coinsurance and no deductible. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with up to a $200 annual eyewear limit, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Paramount Elite Preferred (PPO) offers partially covered dental services with no copay and no coinsurance up to a combined annual maximum of $4,000. While many preventive and comprehensive benefits are included, other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Paramount Elite Preferred (PPO) with no copay, although prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Paramount Elite Preferred (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Paramount Elite Preferred (PPO) covers medical equipment with no copays, though prior authorization may be required for certain items. Durable medical equipment carries a 0% to 25% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts have no coinsurance.
Diagnostic and Radiological Services See details
Paramount Elite Preferred (PPO) provides partial coverage for diagnostic and radiological services, as lab services are not covered. Covered diagnostic procedures require a $50 copay with no coinsurance, while radiological services require prior authorization and range from no copay for diagnostic radiology to a $50 copay for outpatient X-rays and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Paramount Elite Preferred (PPO) covers home health services with no copay and no coinsurance. This benefit allows eligible members to receive covered in-home care with zero out-of-pocket costs.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Paramount Elite Preferred (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Paramount Elite Preferred (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day hospital stay is not required before admission, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered under Paramount Elite Preferred (PPO), featuring a meal benefit for chronic illnesses and a $75 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Prior authorization is required for the meal benefit, and acupuncture is not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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* 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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