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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 $3800.00 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 features a low prescription drug deductible of $55. You will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, with copays starting at just $5 for a one-month supply at preferred locations. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty drugs in Tier 5 are covered at a 32% coinsurance for a one-month supply across all pharmacy networks.
Additional Benefits
The MedMutual Advantage Choice (HMO) plan offers robust medical coverage with a focus on affordable care, featuring no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Specialist visits require a $25 copay with no coinsurance, while emergency room visits carry a $150 copay that is waived if you are admitted. For hospital stays, inpatient care features no coinsurance with a $355 daily copay for the first five days and no copay for unlimited additional days. This plan also includes routine vision, dental, and hearing exams with no copay and no coinsurance. Additional benefits include a $200 annual eyewear allowance with no copay, up to two prescription hearing aids per year with copays between $499 and $999, and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by MedMutual Advantage Choice (HMO), featuring no coinsurance for acute stays with a $355 daily copay for days 1 through 5 and no copay for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and a $370 daily copay for days 1 through 5, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MedMutual Advantage Choice (HMO) with no coinsurance, featuring a $325 copay for outpatient hospital visits, a $395 copay per stay for observation services, and a $320 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay and no coinsurance, while outpatient blood services are covered 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 these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the MedMutual Advantage Choice (HMO) plan, with prior authorization required. Ground ambulance services require a $245 copay with no coinsurance, air ambulance services require a 50% coinsurance with no copay, and transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations (transportation to any health-related location is not covered).
Emergency Services See details
MedMutual Advantage Choice (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no coinsurance and respective copays of $150 and $40, though worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Choice (HMO) covers primary care visits with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Mental health, psychiatric, and physical therapy services require copays between $25 and $40 with no coinsurance, whereas podiatry and routine chiropractic care are not covered. Additional telehealth benefits are available with a copay of no copay to $25 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by MedMutual Advantage Choice (HMO), with no copay and no coinsurance for annual physicals, kidney disease education, and other standard screenings, though weight management programs carry a 70% coinsurance. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, 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 safety modifications, and counseling.
Hearing Services See details
MedMutual Advantage Choice (HMO) partially covers hearing services, providing annual routine hearing exams with no copay and no coinsurance, and up to two prescription hearing aids per year with no coinsurance and a copay ranging from $499 to $999. However, hearing aid fittings and evaluations, OTC hearing aids, and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services under the MedMutual Advantage Choice (HMO) plan are partially covered, including annual routine eye exams with no copay and no coinsurance. Eyewear is covered up to a $200 yearly limit with no copay (featuring 20% coinsurance for contact lenses and no coinsurance for eyeglasses), while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the MedMutual Advantage Choice (HMO) plan, which offers Medicare-covered dental care for a $25 copay and no coinsurance, and routine preventive services like exams, cleanings, x-rays, and fluoride with no copay and no coinsurance. Other preventive services, restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
MedMutual Advantage Choice (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Choice (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by MedMutual Advantage Choice (HMO) with no copays for all items, though coinsurance typically applies. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Choice (HMO) covers diagnostic and radiological services, featuring a $10 copay and no coinsurance for diagnostic procedures, tests, and lab services. Diagnostic radiological services require a minimum $100 copay, outpatient X-rays have a $50 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
MedMutual Advantage Choice (HMO) covers Home Health Services in full, requiring no copay and no coinsurance for these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by MedMutual Advantage Choice (HMO) with no coinsurance, though prior authorization is required and only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, and applicable copayments range from $25 to $40.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Choice (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 hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MedMutual Advantage Choice (HMO) partially covers other services, excluding acupuncture and over-the-counter items. Covered benefits include meals for chronic illness with no copay and no coinsurance, and Travel Plus benefits with a $0.00 to $395.00 copay, 0% to 50% coinsurance, and a $7,500 annual limit, both of which require prior authorization.
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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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