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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 2025, 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 2025.
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 $93.00. 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 $4600.00 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) plan has a $55 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, you can expect to pay a $5.00 copay for preferred generic drugs at a preferred pharmacy. You will then enter the catastrophic coverage phase after your total drug costs reach $2000.00, where you pay nothing for covered drugs.
Additional Benefits
The MedMutual Advantage Choice (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, but no copay for the majority of your stay. Outpatient services, including emergency and urgent care, have copays, while primary care services like doctor visits and mental health services have copays ranging from $20 to $40. Preventive services are covered with no copay, but additional preventive services and some hearing and vision services have coinsurance or copays. The plan also covers dental services with a copay, and offers coverage for ambulance services, home infusion, dialysis, and medical equipment, often with coinsurance. Other services, such as home health and skilled nursing facilities, have no copay, or a copay, and the plan provides an OTC benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $365 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $370 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have copays of $360 and $385, respectively. Ambulatory Surgical Center (ASC) Services have a copay of $350, and outpatient substance abuse services have a copay of $40 for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Choice (HMO) plan. This benefit has a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MedMutual Advantage Choice (HMO), including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a copay of $255, while air ambulance services have a 50% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, have a $110 copay, while Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, and Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, Physician Specialist Services have a $35 copay, Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services each have a $40 copay, Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a copay between $0 and $35. Routine Chiropractic Care is not covered, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The MedMutual Advantage Choice (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services include a 70% coinsurance for weight management programs.
Hearing Services See details
The MedMutual Advantage Choice (HMO) plan covers hearing exams and prescription hearing aids. Routine hearing exams are covered once per year, and prescription hearing aids are covered twice per year with a copay between $499 and $999. Fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The MedMutual Advantage Choice (HMO) plan covers vision services, including routine eye exams once per year and eyewear with a 20% coinsurance for contact lenses. Eyeglasses (lenses and frames) are covered, with a combined maximum plan benefit coverage amount of $200.00 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limitations on the number of visits per year. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. You will pay a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for all services ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Choice (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The MedMutual Advantage Choice (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $10, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $150 and $225, 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 Choice (HMO) plan with no copay and no coinsurance, though authorization is required. 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 Choice (HMO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Choice (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The MedMutual Advantage Choice (HMO) plan's "Other Services" benefit covers over-the-counter (OTC) items, and a meal benefit, but not acupuncture. The "Other 1" service has a coinsurance between 0% and 50% and a copay between $0 and $385.00, and the plan covers a maximum of $7500.00 per year for "MedMutual Advantage Travel Plus". Some services, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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