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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 $5200.00 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) Medicare plan features an annual drug deductible of $300. You can save on prescriptions with no copay for Tier 1 preferred generic drugs filled at preferred pharmacies or through preferred mail order, plus no copay for Tier 6 select care drugs across all pharmacies. Tier 2 generic medications are also highly affordable, costing as low as no copay for preferred mail order and a $5 copay for a one-month supply at a preferred pharmacy. For brand-name and specialty prescriptions, your costs are based on a percentage of the drug cost. You will pay a 21% coinsurance for Tier 3 preferred brand drugs and a 41% coinsurance for Tier 4 non-preferred drugs at both standard and preferred pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply, regardless of the pharmacy or mail order service you choose.
Additional Benefits
The MedMutual Advantage Classic (HMO) plan offers comprehensive healthcare coverage with no copay for primary care visits, home health services, and routine preventive screenings. For specialized care, members pay a $35 copay for specialist visits, while emergency room services require a $130 copay. Inpatient hospital stays feature a $350 daily copay for the first seven days of acute care, with no copay required for subsequent days. This plan also includes valuable supplemental benefits, featuring no copay for routine dental cleanings, annual vision exams, and yearly hearing tests. Members receive up to $200 annually for eyewear, a $1,500 maximum dental benefit, and access to over-the-counter items with no copay. Additionally, the plan covers up to 24 one-way trips per year to approved medical appointments with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by MedMutual Advantage Classic (HMO) with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and a $300 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
MedMutual Advantage Classic (HMO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital, observation, and ambulatory surgical center services, alongside a $35 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the MedMutual Advantage Classic (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive care under this benefit.
Ambulance and Transportation Services See details
MedMutual Advantage Classic (HMO) covers ground ambulance services with a $265 copay and no coinsurance, and air ambulance services with a 50% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
MedMutual Advantage Classic (HMO) covers emergency services with a $130 copay and no coinsurance (waived if admitted to the hospital within 24 hours) and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $130 and $50 copay respectively and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Classic (HMO) covers primary care visits and select telehealth services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $35 copay and no coinsurance. Physical, occupational, and speech therapies are covered with copays ranging from $40 to $45 and no coinsurance, whereas opioid treatment requires a 20% coinsurance with no copay. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered under MedMutual Advantage Classic (HMO), featuring an annual physical, kidney disease education, and routine screenings with no copay and no coinsurance, though weight management programs carry a 70% coinsurance. Several supplemental benefits are not covered, including health education, personal emergency response systems, in-home safety assessments, nutritional/dietary benefits, and counseling.
Hearing Services See details
Hearing services under the MedMutual Advantage Classic (HMO) are partially covered, offering one routine hearing exam per year with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to two per year with no coinsurance and a copay ranging from $499 to $999, though fitting and evaluation, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
MedMutual Advantage Classic (HMO) covers vision services, offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is partially covered with no copay and a 20% coinsurance for contact lenses, providing up to a $200 annual maximum for either contact lenses or one pair of eyeglasses, while upgrades, individual lenses, and individual frames are not covered.
Dental Services See details
MedMutual Advantage Classic (HMO) partially covers dental services up to a $1,500 annual maximum, offering Medicare-covered dental for a $35 copay and no coinsurance. Preventive care like cleanings and exams has no copay and no coinsurance, while advanced treatments like endodontics have no copay and 30% to 50% coinsurance. Other preventive services, prosthodontics, implants, and orthodontics 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. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
MedMutual Advantage Classic (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Classic (HMO) covers medical equipment with no copays, though coinsurance and prior authorization requirements apply to most items. Durable medical equipment requires a 25% coinsurance, prosthetics, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance, and diabetic supplies carry between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Classic (HMO) covers diagnostic and radiological services with prior authorization required, featuring a $10 copay and no coinsurance for diagnostic tests, procedures, and lab services. Outpatient X-rays require a $50 copay, diagnostic radiological services have a $100 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
MedMutual Advantage Classic (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by MedMutual Advantage Classic (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
MedMutual Advantage Classic (HMO) partially covers other services, excluding acupuncture, and provides 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 ranging from $0.00 to $350.00 and 0% to 50% coinsurance up to a $7,500 annual limit.
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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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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.
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