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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 2026, 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 2026.
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 $3600.00 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 features a low $55 drug deductible, offering affordable prescription coverage. Tier 1 preferred generic drugs have no copay at preferred pharmacies and preferred mail-order services, while Tier 6 select care drugs have no copay across all pharmacies. Tier 2 generic medications are also highly accessible, with a copay as low as $5 for a one-month supply at preferred pharmacies. For brand-name and specialty medications, the plan utilizes coinsurance instead of copayments. You can expect a 23% coinsurance for Tier 3 preferred brand drugs, 40% coinsurance for Tier 4 non-preferred drugs, and 32% coinsurance for Tier 5 specialty drugs. These coinsurance rates apply uniformly across preferred and standard pharmacies as well as mail-order services.
Additional Benefits
The MedMutual Advantage Plus (HMO) plan offers robust core medical coverage featuring no copays and no coinsurance for primary care doctor visits, routine annual physicals, and home health services. For specialized medical care, you will pay a $25 copay for specialist visits and a $190 copay for outpatient hospital services with no coinsurance. Inpatient hospital stays require daily copays for the first several days, such as a $355 daily copay for days one through six of acute care, but feature no coinsurance and no copays for longer stays. Emergency care is covered with a $150 copay, while urgent care visits require a $35 copay, with both featuring no coinsurance. The plan also includes valuable supplemental benefits, offering no copays for routine dental, vision, and hearing exams, alongside a $2,000 annual maximum for dental care. Additionally, members benefit from up to 24 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
MedMutual Advantage Plus (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $355 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $370 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MedMutual Advantage Plus (HMO) with no coinsurance, featuring a $190 copay for outpatient hospital services, a $350 copay per stay for observation services, and a $175 copay for ambulatory surgical center visits. Outpatient substance abuse services require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered under MedMutual Advantage Plus (HMO) with a $25.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under MedMutual Advantage Plus (HMO), with ground ambulance services requiring a $225 copay and no coinsurance, and air ambulance services requiring a 50% coinsurance and 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 health-related location is not covered.
Emergency Services See details
MedMutual Advantage Plus (HMO) covers emergency services with a $150 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with no coinsurance and copays of $150 for emergency and $35 for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits covered by MedMutual Advantage Plus (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $25 copay and no coinsurance. Therapy and mental health services have copays ranging from $25 to $45 with no coinsurance, whereas opioid treatment has no copay but requires a 20% coinsurance. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by MedMutual Advantage Plus (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and standard screenings, though weight management programs require a 70% coinsurance and no copay. Sub-services that are not covered under this plan 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 Plus (HMO) partially covers hearing services, providing one routine hearing exam per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $499.00 to $999.00, though hearing aid fittings, OTC hearing aids, and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are covered by MedMutual Advantage Plus (HMO), including one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is partially covered with no copay and a 20% coinsurance for contact lenses under a $100 annual maximum for one pair of glasses or contacts, though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
MedMutual Advantage Plus (HMO) offers partially covered dental services with an annual maximum benefit of $2,000, featuring no copay and no coinsurance for preventive care like exams and cleanings. Other covered services require no copay with 30% to 50% coinsurance (or a $25 copay and no coinsurance for Medicare-covered dental), though prosthodontics, implants, orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MedMutual Advantage Plus (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Plus (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay for all covered services. While there is no copay, members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and therapeutic shoes, and between no coinsurance and 20% coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
MedMutual Advantage Plus (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures, tests, and lab services have a $10 copay and no coinsurance, while radiological services require a $50 copay for X-rays, a $100 minimum copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by MedMutual Advantage Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MedMutual Advantage Plus (HMO) provides coverage for some Cardiac Rehabilitation Services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
MedMutual Advantage Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
MedMutual Advantage Plus (HMO) partially covers other services, offering over-the-counter items and a meal benefit with no copay and no coinsurance, though acupuncture is not covered. The plan also covers a travel benefit with a copay ranging from $0 to $370 and coinsurance from 0% to 50%.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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