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MedMutual Advantage Premium (PPO)

H4497 - 003 - 3
4 out of 5 stars (4 / 5)

MedMutual Advantage Premium (PPO) is a Medicare Advantage Plan by Medical Mutual of Ohio.

This page features plan details for 2025 MedMutual Advantage Premium (PPO) H4497 – 003 – 3 available in Ohio Regions.

Locations

MedMutual Advantage Premium (PPO) is offered in the following locations.

Brown County, Ohio
Butler County, Ohio
Clark County, Ohio

Click to see more locations

Plan Overview

MedMutual Advantage Premium (PPO) offers the following coverage and cost-sharing.

Insurer:Medical Mutual of Ohio
Health Plan Deductible:$1,250 annual deductible
MOOP:$5,150 In and Out-of-network
$3,450 In-network
Drugs Covered:Yes

Ready to sign up for MedMutual Advantage Premium (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

MedMutual Advantage Premium (PPO) has a monthly premium of $129.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $95.50 $33.50 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

MedMutual Advantage Premium (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $55.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$33.50$0.00

Initial Coverage Phase

After you pay your $55.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

MedMutual Advantage Premium (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: 30 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: 30 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: 30 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: 30 Coins – No Copay (Limits Apply)
    • Out-of-Network: 50-70% Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $100-175 copay (Authorization Required)
  • Lab services
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $150-225 copay (Authorization Required)
  • Lab services
    • In-Network: $0-10 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-10 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $50 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $35 copay per visit (Authorization Required)
    • In-Network: $30 copay per visit (Authorization Required)
    • Out-of-Network: 30% coinsurance per visit (Authorization Required)
  • Primary
    • Out-of-Network: 30% coinsurance per visit

Emergency care/Urgent care

  • Urgent care
    • $35 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $30 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: 30% coinsurance (Authorization Required)
    • In-Network: $35 copay (Authorization Required)
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $30 copay (Authorization Required)

Ground ambulance

    • In-Network: $245 copay
    • In-Network: $200 copay
    • Out-of-Network: $200 copay
    • Out-of-Network: $245 copay

Health plan deductible

    • $1,250 annual deductible
    • $1,500 annual deductible

Hearing

  • Fitting/evaluation
    • Not covered
  • Hearing aids
    • In-Network: $499-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 30% coinsurance
  • Hearing aids
    • Out-of-Network: $499-999 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay

Inpatient hospital coverage

    • Out-of-Network: 30% per stay (Authorization Required)
    • In-Network: $365 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • In-Network: $350 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $5,150 In and Out-of-network
      $3,450 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item
    • Out-of-Network: 20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 20% coinsurance (Authorization Required)
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • In-Network: $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $35 copay
    • Out-of-Network: 30% coinsurance
  • Inpatient hospital – psychiatric
    • Out-of-Network: 30% per stay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $35 copay
  • Inpatient hospital – psychiatric
    • In-Network: $370 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $30 copay
    • Out-of-Network: 30% coinsurance
  • Outpatient individual therapy visit
    • In-Network: $30 copay
    • Out-of-Network: 30% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $30 copay
  • Outpatient group therapy visit
    • In-Network: $35 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $30 copay
    • Out-of-Network: 30% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $325 copay per visit (Authorization Required)
    • Out-of-Network: 30% coinsurance per visit (Authorization Required)
    • In-Network: $345 copay per visit (Authorization Required)
    • In-Network: $365 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: 30% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $40 copay (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Occupational therapy visit
    • In-Network: $45 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: 30% per stay (Authorization Required)
    • In-Network: $20 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)

Transportation

    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
    • In-Network: $0 copay (Limits Apply, Authorization Required)

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Routine eye exam
    • Out-of-Network: $50 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglass frames
    • Not covered
  • Other
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for MedMutual Advantage Premium (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on MedMutual Advantage Premium (PPO)? See 2025 MedMutual Advantage Premium (PPO) at MedicareAdvantageRX.com.

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Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

SMID: MULTIPLAN_HCIHNDOGMED01PY25_M

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Medicare has neither approved nor endorsed any information on this site.

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.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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.

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