A non-government entity
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 2025, please refer to our full plan details page.
Paramount Elite Preferred (PPO) is a PPO plan offered by MEDICAL MUTUAL OF OHIO available for enrollment in 2025 to people living in Select counties throughout OH, MI, IN and KY. The overall rating for this plan is not yet available for 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $0.90. You must continue to pay paying your reduced 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 $5700.00 (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 $5700.00 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 Paramount Elite Preferred (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Paramount Elite Preferred (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay a $0 copay for preferred generic drugs at standard and mail order pharmacies. Standard generic drugs have a $45 copay, and preferred brand drugs have a $100 copay. Non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Paramount Elite Preferred (PPO) plan offers a range of benefits with varying costs. This plan includes inpatient hospital stays with a copay, outpatient services with copays ranging from $0-$275, and emergency services with a $100 copay. Additional benefits include no copay for primary care, preventive, hearing, dental, and vision services, as well as home health services. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with a coinsurance or copay.
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 $360 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $275, observation services with a $360 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Paramount Elite Preferred (PPO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Paramount Elite Preferred (PPO) plan. Ground and Air Ambulance Services have a $295 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Paramount Elite Preferred (PPO) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $100 copay.
Primary Care See details
The Paramount Elite Preferred (PPO) plan covers Primary Care Physician Services with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $15 copay.
Preventive Services See details
Preventive services include no copay for the annual physical exam, and additional services like health education, nutritional/dietary benefits, and additional sessions of smoking and tobacco cessation counseling. Other services such as in-home safety assessments, medical nutrition therapy, and counseling services are not covered.
Hearing Services See details
The Paramount Elite Preferred (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $675 per ear every year, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$30, and eyewear with a $200 combined maximum plan benefit per year, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Paramount Elite Preferred (PPO) plan covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments with no copay, but there are limits to the number of visits and periodicity. Other covered dental services include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Paramount Elite Preferred (PPO) plan, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Paramount Elite Preferred (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Paramount Elite Preferred (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and no copay, and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a coinsurance between 0% and 20% with no copay, while Diabetic Therapeutic Shoes/Inserts have no coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Paramount Elite Preferred (PPO) plan. Diagnostic Procedures/Tests have a $50 copay, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $130, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered under the Paramount Elite Preferred (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Paramount Elite Preferred (PPO) plan, however, 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 are not covered. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Paramount Elite Preferred (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Paramount Elite Preferred (PPO) plan includes over-the-counter items with no copay and a maximum benefit of $175 every three months, and a meal benefit with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved