A non-government entity
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 $40.00. 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:
Sign up for MedMutual Advantage Choice (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MedMutual Advantage Choice (HMO) plan has a $55 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For Tier 1 drugs, you will pay a $5 copay at a preferred pharmacy or a $12 copay at a standard pharmacy. For Tier 3 and 4 drugs, you will pay 50% or 32% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D 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 of $355 for the first 5 days, and then no copay for the remainder of the stay. Outpatient services have copays that vary from $40 to $395, while primary care visits have copays between $20 and $45, and specialist visits have a $25 copay. Preventive services, home health services, and many lab services are covered with no copay. The plan also covers hearing and vision services, with routine exams covered. Dental services, ambulance services, and durable medical equipment are covered, but may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $355 copay for days 1-5 and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5 and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the MedMutual Advantage Choice (HMO) plan, including outpatient hospital services with a $340 copay, observation services with a $395 copay, ambulatory surgical center (ASC) services with a $350 copay, and outpatient substance abuse services with 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. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MedMutual Advantage Choice (HMO). Ground ambulance services have a copay of $210, while air ambulance services have a 50% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the MedMutual Advantage Choice (HMO) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a $40 copay. Worldwide Emergency Coverage also has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Choice (HMO) plan covers primary care, chiropractic, occupational therapy, physician specialist services, mental health, physical therapy, telehealth, and opioid treatment program services. Chiropractic services have a $20 copay, occupational therapy services have a $45 copay, physician specialist services have a $25 copay, individual and group mental health sessions have a $40 copay, physical therapy has a $40 copay, and telehealth services have a $0-$25 copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The MedMutual Advantage Choice (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are also covered, though some services are not covered including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home and Bathroom Safety Devices and Modifications, and Counseling Services. Weight Management Programs have a 70% coinsurance. The plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Home-Based Palliative Care, and Remote Access Technologies, all of which are covered.
Hearing Services See details
Hearing services include routine hearing exams once per year, and prescription hearing aids with a copay between $499 and $999 depending on the type of hearing aid. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, 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 with one visit per year, and eyewear with a 20% coinsurance for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Choice (HMO) plan covers Medicare Dental Services with a $30 copay, and also covers Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment, with each service limited to a certain number of visits per year. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Choice (HMO) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the MedMutual Advantage Choice (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and a prior authorization is required. Prosthetics and medical supplies have a 20% coinsurance, while diabetic supplies have between 0% and 20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $10, and lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay between $100 and $175, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $50 copay.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Choice (HMO) plan, with no copay or coinsurance, but 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. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Choice (HMO) plan, with prior authorization required. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The MedMutual Advantage Choice (HMO) plan's "Other Services" benefit covers over-the-counter items, meal benefits, and other services. 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. Other services have a coinsurance between 0% and 50%, with a copay between $0 and $395, and a maximum benefit of $7,500 per year.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
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.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved