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MedMutual Advantage Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Classic (HMO) in 2025, please refer to our full plan details page.
MedMutual Advantage Classic (HMO) is a HMO 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 Classic (HMO) 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 Classic (HMO).
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 Classic (HMO), 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 $95.00 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 Maximum Out-Of-Pocket cost of $4600.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network 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 MedMutual Advantage Classic (HMO) plan has an enhanced alternative drug benefit. The plan has a $95 deductible for prescription drugs. Once the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $5 copay at a preferred pharmacy or no copay through preferred mail order for a preferred generic drug.
Additional Benefits
The MedMutual Advantage Classic (HMO) plan offers a range of benefits with varying costs. Hospital stays have copays, with outpatient services, emergency services, and specialist visits also requiring copays. The plan covers a variety of services, including primary care, preventive care, hearing, vision, and dental, with specific copays or coinsurance amounts detailed for each. Additional benefits include coverage for ambulance services, home health, and skilled nursing facilities, with specific copay amounts. Diagnostic services, medical equipment, and home infusion are also covered, with costs varying based on the specific service. The plan also provides coverage for over-the-counter items and offers a travel benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the MedMutual Advantage Classic (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $290 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center services are covered. Outpatient hospital services have a $310 copay, observation services have a $400 copay, and ambulatory surgical center services have a $350 copay. Outpatient substance abuse services are covered, with individual and group sessions having a copay between $35.00 and $35.00. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MedMutual Advantage Classic (HMO) plan, including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $225 copay, and air ambulance services have a 50% coinsurance. Transportation services to any health-related location are not covered, however, transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the MedMutual Advantage Classic (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered. Chiropractic Services have a $20 copay, Occupational Therapy Services have a $45 copay, and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The MedMutual Advantage Classic (HMO) plan covers a variety of preventive services including Medicare-covered preventive services, annual physical exams, and additional preventive services. Additional preventive services may include coinsurance for Weight Management Programs. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include routine hearing exams, covered once per year, and prescription hearing aids. The plan has a copay between $499 and $999 for prescription hearing aids (all types), but does not cover fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, or over the ear, or OTC hearing aids.
Vision Services See details
Vision Services includes coverage for routine eye exams with no copay, and eyewear with a 20% coinsurance for contact lenses, but eyeglass lenses, eyeglass frames, and upgrades are not covered. You are eligible for one routine eye exam every year, and a combined maximum of $200 per year for eyewear.
Dental Services See details
The MedMutual Advantage Classic (HMO) plan covers Medicare Dental Services with a $35 copay, and other dental services with a $3,000 maximum benefit per year. Oral exams are covered for 2 visits per year, and dental x-rays are covered for 1 per year. Other diagnostic dental services, restorative services, adjunctive general services, and oral and maxillofacial surgery have a 30% coinsurance, while endodontics and periodontics have a 50% coinsurance. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay and between 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Classic (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the MedMutual Advantage Classic (HMO) plan, with a 20% coinsurance for durable medical equipment and a 20% coinsurance for Medicare-covered prosthetic devices and medical supplies. Diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay between $100 and $175, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Classic (HMO) 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 following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Classic (HMO) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The MedMutual Advantage Classic (HMO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. The plan provides up to $90 every three months for over-the-counter items, including nicotine replacement therapy and naloxone. Other 1 services have a $0-$400 copay and 0-50% coinsurance, and the plan covers up to $7,500 per year for MedMutual Advantage Travel Plus.
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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.
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