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MedMutual Advantage Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Plus (HMO) in 2025, please refer to our full plan details page.
MedMutual Advantage Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $90.00. 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 $3450.00 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 Plus (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 pharmacy. For example, in the initial coverage phase, preferred generic drugs have a $5 copay at a preferred pharmacy, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MedMutual Advantage Plus (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll have no copay for primary care visits, routine hearing exams, and preventive services, but some services like specialist visits, vision care, and dental have copays or coinsurance. This plan also covers ambulance services, emergency care, and offers additional benefits like home health, home infusion, and dialysis services with varying cost-sharing. The plan includes coverage for medical equipment and diagnostic services, and also offers over-the-counter benefits, meal benefits, and other services, while excluding certain services such as cardiac rehabilitation and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $355 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $370 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $220 copay, observation services have a $350 copay, and ASC services have a $175 copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the MedMutual Advantage Plus (HMO) plan with a $25 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MedMutual Advantage Plus (HMO), with a $190 copay for ground ambulance services and a 50% coinsurance for air ambulance services. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $130 copay, while Urgently Needed Services and Worldwide Urgent Coverage have a $25 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Plus (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $45 copay, Physician Specialist Services with a $25 copay, Mental Health Specialty Services with a $25 copay, and Physical Therapy and Speech-Language Pathology Services with a $40 copay. Additionally, the plan offers Additional Telehealth Benefits with a copay ranging from $0 to $25, and Opioid Treatment Program Services with 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The MedMutual Advantage Plus (HMO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Weight management programs have a coinsurance of 70%. This plan also covers Kidney Disease Education Services, Other Preventive Services, and additional sessions for smoking and tobacco cessation counseling. Some services, such as health education and counseling services, are not covered.
Hearing Services See details
The MedMutual Advantage Plus (HMO) plan covers routine hearing exams once per year with no copay and also covers prescription hearing aids with a copay between $499 and $999 for all types, but does not cover fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, or OTC hearing aids.
Vision Services See details
Vision Services includes routine eye exams once per year with no copay, and eyewear benefits with 20% coinsurance for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan offers a combined maximum plan benefit coverage amount of $100 for eyewear.
Dental Services See details
The MedMutual Advantage Plus (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services with a $1,000 annual maximum. Oral exams are covered with a $25 copay for up to two visits per year, and dental X-rays and fluoride treatment are covered for one visit per year. Other diagnostic dental services, restorative services, adjunctive general services, and oral and maxillofacial surgery are covered with a 30% coinsurance, while endodontics and periodontics are covered with a 50% coinsurance. Orthodontic services, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Plus (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, are covered under the MedMutual Advantage Plus (HMO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices 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, including all diagnostic services, are covered with prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, and Diagnostic Radiological Services have a copay up to $175. Therapeutic Radiological Services have a 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 Plus (HMO) plan, with no copay or coinsurance, but require authorization. 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 Plus (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the MedMutual Advantage Plus (HMO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "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. Over-the-counter (OTC) items are covered with a maximum benefit of $65 every three months, including Nicotine Replacement Therapy (NRT), but not all drugs on the CMS OTC list. Meal benefits are covered and require prior authorization. Other 1 benefits are covered, with a coinsurance of 0% to 50% and a copay of $0 to $355, with a maximum amount of $7500 every year.
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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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