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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 $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 has a $95.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, preferred generic drugs have a $5.00 copay at preferred pharmacies and no copay via mail order. Standard generic drugs have a $42.00 copay at preferred pharmacies and a $40.00 copay via mail order. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The MedMutual Advantage Classic (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. The plan also covers ambulance services with copays, emergency services with copays, and primary care with no copay for primary care physician services. Preventive services are covered, including routine eye exams with no copay, and hearing services with copays for exams and hearing aids. Dental services are covered with copays and coinsurance, and home health services have no copay or coinsurance. The plan also offers benefits like OTC items, with other services covered with copays and coinsurance.
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'll pay a $290 copay for days 1-7 and no copay for days 8-90; additional days are covered, and non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-5 and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a $310 copay, Observation Services have a $350 copay, Ambulatory Surgical Center (ASC) Services have a $350 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40. Outpatient blood services include an enhanced benefit with three (3) pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Classic (HMO) plan, with a copay of $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $225 copay, while air ambulance services have a 50% coinsurance. Transportation services to any health-related location are not covered, but the plan offers up to 24 one-way trips per year to plan-approved health-related locations via bus/subway, medical transport, and other modes of transportation.
Emergency Services See details
Emergency Services, including 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 $35 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Classic (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $45 copay, while physician specialist services have a $40 copay. Mental health services have a $40 copay for both individual and group sessions, and physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The MedMutual Advantage Classic (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, weight management programs with 70% coinsurance, home-based palliative care, additional smoking cessation counseling, a fitness benefit, remote access technologies, kidney disease education services, and other preventive services. 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, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and prescription hearing aids, with fitting/evaluation for hearing aids and OTC hearing aids not covered. Routine hearing exams are covered for one visit every year, and prescription hearing aids have a copay between $499 and $999 for two visits every year.
Vision Services See details
The MedMutual Advantage Classic (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with 20% coinsurance for contact lenses, up to a combined maximum of $200 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Classic (HMO) plan covers Medicare dental services with a $40 copay, other dental services with a $3,000 maximum, and offers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Fluoride Treatment. This plan also covers Restorative Services, Adjunctive General Services, and Oral and Maxillofacial Surgery with a 30% coinsurance, and Endodontics and Periodontics with a 50% coinsurance, but does not cover Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 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 benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Medical Supplies and Diabetic Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $10, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $175, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Classic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MedMutual Advantage Classic (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MedMutual Advantage Classic (HMO) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The MedMutual Advantage Classic (HMO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items with a maximum benefit of $80 every three months, and "Other 1" services with a coinsurance between 0% and 50% and a copay between $0 and $350. 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.
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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.
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