A non-government entity
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 $94.00. 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:
Sign up for MedMutual Advantage Plus (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 Plus (HMO) prescription drug plan features a low drug deductible of $55. You will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies and preferred mail-order services, as well as no copay for Tier 6 select care drugs across all pharmacy types. For Tier 2 generic drugs, copays start as low as $5 for a one-month supply at preferred pharmacies and preferred mail-order. Higher-tier medications require coinsurance rather than set copays under this plan. You will pay 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 options.
Additional Benefits
The MedMutual Advantage Plus (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $25 copay, while emergency care has a $150 copay and urgent care costs $35. For hospital stays, inpatient acute care requires a $375 daily copay for the first six days, followed by no copay for additional days. This plan also provides valuable supplemental benefits, including routine dental, vision, and hearing exams with no copay or coinsurance. Dental services are covered up to a $2,000 annual maximum with a 30% to 50% coinsurance for comprehensive care, while routine eyewear is covered up to $100 annually. Additionally, members benefit from a $60 quarterly over-the-counter allowance and up to 24 one-way transportation trips per year to plan-approved locations at no cost.
Inpatient Hospital See details
MedMutual Advantage Plus (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $375 daily copay for days 1 through 6 and no copay for days 7 through 90 with unlimited additional days, while psychiatric stays require a $370 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
MedMutual Advantage Plus (HMO) covers outpatient services with no coinsurance, featuring a $220 copay for outpatient hospital services and a $330 copay per stay for observation services. Ambulatory surgical center services require a $200 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by MedMutual Advantage Plus (HMO) with a $25.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MedMutual Advantage Plus (HMO), featuring a $240 copay and no coinsurance for ground ambulance, and a 50% coinsurance with no copay for air ambulance services. Transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under MedMutual Advantage Plus (HMO) are covered with a $150 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care is covered with a $35 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $150 emergency copay, a $35 urgent care copay, and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MedMutual Advantage Plus (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical and occupational therapies require copays of $40 and $45 with no coinsurance, while podiatry is not covered and chiropractic services are partially covered with routine and other chiropractic services not covered.
Preventive Services See details
Preventive Services under the MedMutual Advantage Plus (HMO) are partially covered, with annual physicals, kidney disease education, and other preventive screenings available with no copay and no coinsurance. While weight management programs are covered with a 70% coinsurance, several additional services are not covered, including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by MedMutual Advantage Plus (HMO), offering one annual routine hearing exam with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $499.00 and $999.00, but OTC hearing aids, fitting/evaluations, and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
MedMutual Advantage Plus (HMO) provides partial coverage for vision services, featuring one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay up to a $100 annual limit for either one pair of eyeglasses or contact lenses (which have a 20% coinsurance), while individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MedMutual Advantage Plus (HMO) up to a $2,000 annual maximum, featuring Medicare-covered dental for a $25 copay and no coinsurance, alongside key preventive care with no copay and no coinsurance. Comprehensive options like restorative and periodontics services are covered with no copay and 30% to 50% coinsurance, though other preventive services, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MedMutual Advantage Plus (HMO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance. Covered Part B insulin is available for a $35 copay and no coinsurance to 20% coinsurance, with no plan-level deductible.
Dialysis Services See details
MedMutual Advantage Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
MedMutual Advantage Plus (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays. A 20% coinsurance applies to most equipment and devices, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
MedMutual Advantage Plus (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic procedures and lab services for a $10 copay and no coinsurance. Diagnostic radiological services require a minimum $100 copay, outpatient X-rays carry a $50 copay plus coinsurance, and therapeutic radiological services have a minimum 20% coinsurance.
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) covers Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. While some services are covered, specific options such as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
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 hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MedMutual Advantage Plus (HMO) partially covers other services, offering a $60 quarterly over-the-counter item allowance and a chronic illness meal benefit with no copay and no coinsurance. The MedMutual Advantage Travel Plus benefit is also covered with copays ranging from no copay to $375 and coinsurance from no coinsurance to 50%, while acupuncture is not covered.
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