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Paramount Elite Preferred (PPO)

H5232 - 001 - 0
Plan Not Rated

Paramount Elite Preferred (PPO) is a Medicare Advantage Plan by Paramount Elite Medicare Plans.

This page features plan details for 2025 Paramount Elite Preferred (PPO) H5232 – 001 – 0 available in Select counties throughout OH, MI, IN and KY.

Locations

Paramount Elite Preferred (PPO) is offered in the following locations.

Adams County, Indiana
Adams County, Ohio
Allen County, Indiana

Click to see more locations

Plan Overview

Paramount Elite Preferred (PPO) offers the following coverage and cost-sharing.

Insurer:Paramount Elite Medicare Plans
Health Plan Deductible:$0
MOOP:$5,700 In and Out-of-network
$4,200 In-network
$5,700 Out-of-network
Drugs Covered:Yes

Ready to sign up for Paramount Elite Preferred (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

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Paramount Elite Preferred (PPO) qualifies for a monthly Medicare Give Back Benefit of $0.90.

Premium Reduction:$0.90

Premium Breakdown

Paramount Elite Preferred (PPO) has a monthly premium of $0.00. 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 $0.00 $0.00 $0.90 $
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

Paramount Elite Preferred (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
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
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 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

Paramount Elite Preferred (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: No Coins – No Co pay
  • Endodontics
    • In-Network: No Coins – No Co pay
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00-0.00 Copay
    • Out-of-Network: 30% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – 0.00-0.00 Copay
    • Out-of-Network: 30% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – 0.00-0.00 Copay
    • Out-of-Network: 30% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00-0.00 Copay
    • Out-of-Network: 30% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $50 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 10% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-130 copay (Authorization Required)
    • Out-of-Network: 10% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 10% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $50 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $10 copay per visit
  • Specialist
    • Out-of-Network: $40 copay per visit
    • In-Network: $25 copay per visit

Emergency care/Urgent care

  • Urgent care
    • $35 copay per visit (always covered)
  • Emergency
    • $100 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • In-Network: $10 copay
  • Foot exams and treatment
    • In-Network: $25 copay
    • Out-of-Network: $55 copay

Ground ambulance

    • In-Network: $295 copay
    • Out-of-Network: $295 copay

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • In-Network: $0-30 copay
    • Out-of-Network: $0 copay or 10% coinsurance
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay or 10% coinsurance (Limits Apply)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay or 10% coinsurance (Limits Apply)
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • In-Network: $360 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: $360 per stay
      $360 per day for days 1 through 90 (Authorization Required)

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

    • $5,700 In and Out-of-network
      $4,200 In-network
      $5,700 Out-of-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 40% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)

Medicare Part B drugs

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

Mental health services

  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $30 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $295 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $60 copay
  • Outpatient individual therapy visit
    • In-Network: $30 copay
    • Out-of-Network: $60 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $60 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: $295 per stay
      $295 per day for days 1 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $30 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $30 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $60 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 40% coinsurance per visit (Authorization Required)
    • In-Network: $0-275 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $15 copay (Authorization Required)
    • Out-of-Network: $30 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $15 copay (Authorization Required)
    • Out-of-Network: 10% coinsurance (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: 40% per stay
      40% per day for days 1 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $30 copay (Limits Apply)
  • Eyeglass frames
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered

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

    • Covered

Ready to sign up for Paramount Elite Preferred (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

Table of Contents

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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

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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.

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