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MedMutual Advantage Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Choice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Choice (HMO) in 2026, please refer to our full plan details page.
MedMutual Advantage Choice (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 Choice (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 Choice (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 Choice (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 $55.00 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 $3700.00 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 Choice (HMO) prescription drug plan features a low $55 drug deductible and offers significant savings on many common medications. There is no copay for Tier 1 preferred generics and Tier 6 select care drugs when filled through preferred pharmacies or preferred mail-order services. For Tier 2 generic drugs, you will pay a low copay starting at just $5 for a one-month supply at a preferred pharmacy. For brand-name and specialty medications, costs are based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs have a 40% coinsurance at all pharmacies. Specialty medications in Tier 5 are covered with a 32% coinsurance for a one-month supply.
Additional Benefits
The MedMutual Advantage Choice (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and annual preventive care. For inpatient hospital stays, members pay a $335 daily copay for the first five days and no copay for subsequent days, while emergency room visits require a $150 copay. Outpatient surgical services and specialist visits are also covered with no coinsurance, requiring copays of $320 to $325 and $25 respectively. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay and no coinsurance. Members receive up to 24 one-way transportation trips to approved locations per year with no copay and no coinsurance, alongside a $200 annual allowance for eyewear. Skilled nursing facility care features no copay for the first 20 days, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
MedMutual Advantage Choice (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $335 daily copay for days 1 through 5 and no copay for days 6 and beyond. Inpatient psychiatric care is also covered with no coinsurance at a $370 daily copay for days 1 through 5 and no copay for days 6 through 90, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MedMutual Advantage Choice (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $320 copay, ambulatory surgical center services for a $325 copay, and observation services for a $400 copay per stay. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Choice (HMO) with a $25.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MedMutual Advantage Choice (HMO), with ground ambulance services requiring a $225 copay (no coinsurance) and air ambulance requiring 50% coinsurance (no copay). Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
MedMutual Advantage Choice (HMO) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, with no coinsurance for either service. Worldwide emergency services are partially covered up to a $50,000 lifetime limit with no coinsurance, requiring a $150 copay for emergency care and a $40 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Choice (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Mental health, psychiatric, and physical/occupational therapy services range from a $25 to $45 copay with no coinsurance, while opioid treatment features no copay and 20% coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services under the MedMutual Advantage Choice (HMO) are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and other preventive screenings. Additional preventive benefits are partially covered with no copay, including weight management programs at a 70% coinsurance, but sub-services such as health education, in-home safety assessments, PERS, 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, and counseling are not covered.
Hearing Services See details
MedMutual Advantage Choice (HMO) partially covers hearing services, providing one annual routine hearing exam with no copay or coinsurance and up to two prescription hearing aids per year with no coinsurance and a copay ranging from $499 to $999. Fitting and evaluation exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MedMutual Advantage Choice (HMO), featuring annual routine eye exams with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered up to a $200 yearly limit with no copay or deductible, but contact lenses require a 20% coinsurance, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
MedMutual Advantage Choice (HMO) offers partially covered dental services, with Medicare-covered dental care requiring a $25 copay and no coinsurance. Preventive care such as exams, cleanings, x-rays, and fluoride is covered with no copay and no coinsurance, but other preventive, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
MedMutual Advantage Choice (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the MedMutual Advantage Choice (HMO) plan with no copayment and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Choice (HMO) covers medical equipment with no copay, though prior authorization is required for durable medical equipment and prosthetics. A 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies carry a coinsurance ranging from 0% to 20%.
Diagnostic and Radiological Services See details
MedMutual Advantage Choice (HMO) covers diagnostic procedures and lab services with a $10 copay and no coinsurance, subject to prior authorization. Radiological services are also covered under the plan, featuring a $50 copay for X-rays, a minimum $100 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
MedMutual Advantage Choice (HMO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by MedMutual Advantage Choice (HMO) with 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 and carry copays ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Choice (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by MedMutual Advantage Choice (HMO), excluding acupuncture and over-the-counter items. Covered benefits require prior authorization and include meals for chronic illnesses with no copay and no coinsurance, as well as Travel Plus benefits with a $0 to $400 copay and 0% to 50% coinsurance up to a $7,500 yearly 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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