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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 $127.00. 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 $55.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5.00 copay at a preferred pharmacy, while preferred brand drugs have 50% coinsurance at any pharmacy. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs. However, if you qualify for the low-income subsidy, you will pay $13.60. Be sure to check the plan's formulary for specific drug coverage.
Additional Benefits
The MedMutual Advantage Plus (HMO) plan provides coverage for a variety of services, including inpatient and outpatient care, with varying copays. You'll pay a copay for services like inpatient hospital stays, outpatient services, and specialist visits. Preventative services, primary care physician services, and home health services are available with no copay. This plan also offers coverage for hearing, vision, and dental services, each with specific limitations and cost-sharing. Additional benefits include ambulance services, emergency care, and medical equipment, with applicable copays and coinsurance. Be aware that certain services like some dental and vision services, along with some home health and other services, may not be covered.
Inpatient Hospital See details
The MedMutual Advantage Plus (HMO) plan covers inpatient hospital stays, including acute and psychiatric care. For acute care, you'll pay a $375 copay for days 1-6, and no copay for days 7-90. For psychiatric care, the copay is $370 for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, as well as additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $250 copay, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay, and outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MedMutual Advantage Plus (HMO) plan with a $25 copay.
Ambulance and Transportation Services See details
The MedMutual Advantage Plus (HMO) plan covers ambulance and transportation services, including services not usually covered by Medicare plans, but requires prior authorization. Ground ambulance services have a $235 copay, while air ambulance services have a 50% coinsurance. Transportation services to any health-related location are limited to 24 one-way trips per year, and other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the MedMutual Advantage Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $130 copay, and Urgently Needed Services have a $25 copay, with no coinsurance for any of these services; 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, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with a $0-$25 copay, 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 annual physical exams and additional preventive services with no copay. Some additional preventive services, such as Health Education, In-Home Safety Assessment, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with one visit per year, and prescription hearing aids with a copay between $499 and $999 for two visits per year, while fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The MedMutual Advantage Plus (HMO) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a 20% coinsurance for contact lenses, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MedMutual Advantage Plus (HMO) plan covers Medicare dental services with a $25 copay, and other dental services including oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatment (1 per year). Orthodontic, restorative, adjunctive general, endodontic, periodontic, prosthodontic, maxillofacial prosthetics, implant, prosthodontic, oral and maxillofacial surgery, and orthodontics services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Plus (HMO) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies also have a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered by the MedMutual Advantage Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $150 and $225, 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 and no 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 covered, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Plus (HMO) plan, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The MedMutual Advantage Plus (HMO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter items are covered with a maximum benefit of $70 every three months, and other services have a coinsurance between 0% and 50% and a copay between $0 and $375.
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.
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