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MedMutual Advantage Secure (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MedMutual Advantage Secure (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MedMutual Advantage Secure (HMO-POS) in 2025, please refer to our full plan details page.
MedMutual Advantage Secure (HMO-POS) is a HMO-POS 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 Secure (HMO-POS) 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 Secure (HMO-POS).
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 Secure (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 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 Secure (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MedMutual Advantage Secure (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays, and partial hospitalization with a $30 copay. The plan also covers ambulance and transportation services, emergency services, and primary care services, with varying copays for each. Preventive, hearing, vision, and dental services are also included, with routine eye exams and dental services covered, and prescription hearing aids covered up to two times per year. Additional benefits include home infusion services, dialysis services, medical equipment, and diagnostic services, with copays and coinsurance applying to certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $335 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $375 copay, observation services with a $395 copay, and ambulatory surgical center services with a $275 copay. Individual and group sessions for outpatient substance abuse have a $30 copay, and outpatient blood services are covered.
Partial Hospitalization See details
Partial hospitalization is covered by the MedMutual Advantage Secure (HMO-POS) plan, with a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MedMutual Advantage Secure (HMO-POS) plan, with prior authorization required. Ground ambulance services have a $200 copay, while air ambulance services have a 50% coinsurance. Transportation services to plan-approved health-related locations are covered for 24 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the MedMutual Advantage Secure (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage each have a $110 copay, and Urgently Needed Services has a $30 copay. Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, while routine chiropractic care is not covered. Occupational Therapy Services have a $45 copay. Physician Specialist Services have a $30 copay, and mental health and psychiatric individual and group sessions have a $30 copay. Other Health Care Professional services have a copay between $0 and $45, and physical therapy and speech-language pathology services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $30, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The MedMutual Advantage Secure (HMO-POS) 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%. Other services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams, covered once per year, and prescription hearing aids, covered up to two times per year with a copay between $499 and $999. 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 Secure (HMO-POS) plan covers vision services, including routine eye exams once per year. Eyewear, specifically contact lenses, are covered with a 20% coinsurance, with a combined maximum plan benefit coverage of $100 per year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, with other services covered up to an $850 annual maximum. This plan covers oral exams (2 per year), dental x-rays (1 per year), and prophylaxis (cleaning) (2 per year), and fluoride treatment (1 per year). Other diagnostic dental services, restorative services, adjunctive general services, and oral and maxillofacial surgery are covered with 30% coinsurance, while endodontics and periodontics are covered with 50% coinsurance. However, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MedMutual Advantage Secure (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the MedMutual Advantage Secure (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a coinsurance that varies between 0% and 20% depending on the specific service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $10, Lab Services with no copay, Diagnostic Radiological Services with a copay between $100 and $175, Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with a $50 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the MedMutual Advantage Secure (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MedMutual Advantage Secure (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which has a maximum benefit of $80 every three months, and "Other 1" services, which have a copay of $0-$395 and a coinsurance of 0-50%. 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.
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