MedMutual Advantage Classic (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $285 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a $360 copay, Observation Services have a $350 copay, and Ambulatory Surgical Center (ASC) Services have a $350 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40.

Partial Hospitalization See details

Partial Hospitalization is covered by the MedMutual Advantage Classic (HMO) plan with a $40 copay.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered under the MedMutual Advantage Classic (HMO) plan. Ground Ambulance Services have a $275 copay, while Air Ambulance Services have a 50% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, using bus/subway, medical transport, or other transportation methods.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the MedMutual Advantage Classic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.

Primary Care See details

The MedMutual Advantage Classic (HMO) plan offers Primary Care services with no copay. Chiropractic services have a $20 copay, while Occupational Therapy Services have a $45 copay and no coinsurance. Physician Specialist Services have a $25 copay. Mental Health and Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay with no coinsurance. Additional Telehealth Benefits have a copay between $0-$25, and Opioid Treatment Program Services have 20% coinsurance.

Preventive Services See details

The MedMutual Advantage Classic (HMO) plan covers several preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services like weight management programs which have a 70% coinsurance. Some services are not covered, including health education, in-home safety assessments, and counseling services.

Hearing Services See details

Hearing services with MedMutual Advantage Classic (HMO) include routine hearing exams covered once per year, and prescription hearing aids with a copay between $499 and $999 for all types, while fitting/evaluation for hearing aids, prescription hearing aids for inner, outer, and 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 20% coinsurance for contact lenses, with a combined maximum benefit of $200 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental Services include coverage for oral exams with a $25 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) with a $25 copay, and fluoride treatments with a $25 copay. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0-20%. 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. There is a 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits are covered by the MedMutual Advantage Classic (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered.

Prosthetics/Medical Supplies have a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance. 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, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $150 and $225, 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. However, Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the MedMutual Advantage Classic (HMO) plan. Prior authorization is required for these services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Classic (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.

Other Services See details

Other Services include coverage for Over-the-Counter (OTC) Items, Meal Benefit, and Other 1. 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. Other 1 has a copay of $0 - $360 and a coinsurance of 0% - 50%.