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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 2026, 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 2026.
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 $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 Maximum Out-Of-Pocket cost of $4900.00 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 features a $300 annual drug deductible. You can save on prescription costs with no copay for Tier 1 preferred generics filled at preferred pharmacies or through preferred mail order. Additionally, Tier 2 generics have no copay through preferred mail order, and Tier 6 select care drugs feature no copay regardless of the pharmacy or supply duration. Other Tier 1 and Tier 2 prescriptions carry copays ranging from $5 to $30 depending on the tier, pharmacy type, and supply length. For higher-tier medications, you will pay coinsurance, which is set at 21% for Tier 3 preferred brands, 41% for Tier 4 non-preferred drugs, and 29% for Tier 5 specialty drugs.
Additional Benefits
The MedMutual Advantage Classic (HMO) offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care doctor visits and home health services. Specialist visits, urgent care, and physical therapy are available with a low $35 copay and no coinsurance. For more intensive care, the plan features set copayments with no coinsurance, including a $130 copay for emergency room visits and a $350 daily copay for the first seven days of an inpatient hospital stay. In addition to medical care, members benefit from dental, vision, and hearing coverage, including routine exams with no copay and no coinsurance. Comprehensive dental services are covered up to a $2,500 annual limit with no copay and 30% to 50% coinsurance, while eyewear and hearing aids are also partially covered. Other valuable perks include no copay or coinsurance for over-the-counter items, chronic illness meals, and the first 20 days of skilled nursing facility care.
Inpatient Hospital See details
MedMutual Advantage Classic (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 7 of acute stays and a $300 daily copay for days 1 through 5 of psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the MedMutual Advantage Classic (HMO) are covered with no coinsurance, featuring a $350 copay for outpatient hospital and ambulatory surgical center services, and a $400 copay per stay for observation services. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Classic (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
MedMutual Advantage Classic (HMO) covers ground ambulance services with a $245 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
MedMutual Advantage Classic (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no coinsurance and matching copays, though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Classic (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and psychiatric services require a $35 copay and no coinsurance. Occupational therapy has a $45 copay with no coinsurance, opioid treatment has a 20% coinsurance with no copay, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by the MedMutual Advantage Classic (HMO), offering most services like annual physical exams and kidney disease education with no copay and no coinsurance, while weight management programs require a 70% coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, 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/bathroom safety modifications, and counseling.
Hearing Services See details
MedMutual Advantage Classic (HMO) offers partially covered hearing services, including one routine hearing exam per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $499 to $999, while fitting evaluations, OTC hearing aids, and inner ear, outer ear, or over the ear models are not covered.
Vision Services See details
MedMutual Advantage Classic (HMO) partially covers vision services, offering one routine eye exam per year with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is also partially covered up to a $200 annual limit with no copay and a 20% coinsurance for contact lenses for either one pair of glasses or contact lenses, though separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
MedMutual Advantage Classic (HMO) covers dental services up to a $2,500 annual maximum, offering routine preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental for a $35 copay and no coinsurance. The benefit is partially covered, requiring no copay and 30% to 50% coinsurance for comprehensive services like fillings, root canals, and oral surgery, while implants, orthodontics, prosthodontics, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MedMutual Advantage Classic (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have 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 under the MedMutual Advantage Classic (HMO) plan with no copay and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the MedMutual Advantage Classic (HMO) with no copays, though coinsurance and prior authorization may be required. Durable medical equipment carries a 25% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Classic (HMO) covers diagnostic tests, procedures, and lab services with a $10 copay and no coinsurance, subject to prior authorization. Radiological services also require prior authorization and feature a $50 copay for X-rays, a $100 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by the MedMutual Advantage Classic (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MedMutual Advantage Classic (HMO) covers Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though only some services are covered. Standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Classic (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond standard Medicare coverage are not covered.
Other Services See details
Other services are partially covered by MedMutual Advantage Classic (HMO), excluding acupuncture but offering over-the-counter items and chronic illness meals with no copay and no coinsurance. The MedMutual Advantage Travel Plus benefit is also covered with a copay of $0.00 to $400.00 and 0% to 50% coinsurance up to a $7,500 annual limit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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