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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 you use. For preferred generic drugs, you will pay a $5 copay at a preferred pharmacy, or $12 at a standard pharmacy. For preferred brand drugs, you will pay 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 inpatient and outpatient hospital services with varying copays. You'll also find coverage for ambulance and transportation services, emergency services, and primary care, with copays for services like specialist visits and mental health. Preventive services and home health services are covered, as well as hearing, vision, and dental services. This plan also includes coverage for home infusion services, dialysis, medical equipment, and diagnostic services with copays or coinsurance. Other benefits include skilled nursing facility care, cardiac rehabilitation, and other services such as over-the-counter items and a travel benefit.
Inpatient Hospital See details
Inpatient Hospital benefits with MedMutual Advantage Plus (HMO) include coverage for Inpatient Hospital-Acute with a $375 copay for days 1-6, and no copay for days 7-90, as well as Inpatient Hospital Psychiatric with a $370 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, outpatient blood services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services have a $220 copay, observation services have a $330 copay, ambulatory surgical center services have a $175 copay, and outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services include an enhanced benefit where the three-pint deductible is waived.
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
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $190 copay, while air ambulance services have 50% coinsurance. Transportation Services to a plan-approved health-related location 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, including Worldwide Emergency Coverage, have a $130 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Urgent Coverage has a $25 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MedMutual Advantage Plus (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, specialist services with a $25 copay, mental health and psychiatric 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
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Weight Management Programs have a 70% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams, covered once per year, and prescription hearing aids, covered twice per year, with a copay between $499 and $999; fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, and over-the-ear hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
The MedMutual Advantage Plus (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a 20% coinsurance for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan also offers a combined maximum plan benefit coverage amount of $100 per year for eyewear.
Dental Services See details
Dental Services are covered and include oral exams with a $25 copay, dental x-rays, prophylaxis (cleaning) with a $25 copay, and fluoride treatment with a $25 copay. 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
The MedMutual Advantage Plus (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the MedMutual Advantage Plus (HMO) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by MedMutual Advantage Plus (HMO), with a 20% coinsurance for Durable Medical Equipment, Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, and Medicare-covered Diabetic Supplies and Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
The MedMutual Advantage Plus (HMO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $10, and lab services with no copay. Diagnostic radiological services have a copay up to $175, while therapeutic radiological services have a coinsurance of at least 20%, 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 prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the MedMutual Advantage Plus (HMO) plan, but the plan does not cover any of the sub-services. Prior authorization is required for this benefit.
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, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, and Meal Benefit, but 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. OTC items have a maximum benefit coverage of $70 every three months. Other Services include a MedMutual Advantage Travel Plus benefit with a coinsurance of 0-50% and a copay of $0-$375, with a maximum amount of $7500 every year.
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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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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