2022 MedMutual Advantage Premium (PPO)

MedMutual Advantage Premium (PPO) H4497-003 is a 2022 Medicare Advantage Plan or Part-C by Medical Mutual of Ohio available to residents in Ohio. This plan includes additional prescription drug (Part-D) coverage. The MedMutual Advantage Premium (PPO) has a monthly premium of $134.00 and has an in-network maximum out-of-pocket limit of $3,450 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,450 out-of-pocket. This can be a extremely nice safety net.

MedMutual Advantage Premium (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Medical Mutual of Ohio works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MedMutual Advantage Premium (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medical Mutual of Ohio and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Medical Mutual of Ohio except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Medical Mutual of Ohio Medicare Advantage Plan Costs

MedMutual Advantage Premium (PPO) Part-C Premium

Medical Mutual of Ohio charges a $127.20 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H4497-003 Part-D Deductible and Premium

MedMutual Advantage Premium (PPO) has a monthly drug premium of $72.80 and a $55.00 drug deductible. This Medical Mutual of Ohio plan offers a $72.80 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Medical Mutual of Ohio above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $72.80 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Medical Mutual of Ohio Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Medical Mutual of Ohio plan does offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The MedMutual Advantage Premium (PPO) medicare insurance offers a $39.30 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $47.60 for 75% low income subsidy $56.00 for 50% and $64.40 for 25%.

H4497-003 Formulary or Drug Coverage

MedMutual Advantage Premium (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 MedMutual Advantage Premium (PPO) H4497-003 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$6
Tier 2	$5	$12
Tier 3	$42	$47
Tier 4	50%	50%
Tier 5	32%	32%

*Initial Coverage Phase and 30 day supply

2021 MedMutual Advantage Premium (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	30% coinsurance
Diagnostic services	55-70% coinsurance (Out-of-Network)
Endodontics	55-70% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Extractions	55-70% coinsurance (Out-of-Network)
Extractions	30% coinsurance
Non-routine services	30% coinsurance
Non-routine services	55-70% coinsurance (Out-of-Network)
Periodontics	50% coinsurance
Periodontics	55-70% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	55-70% coinsurance (Out-of-Network)
Restorative services	30% coinsurance

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Deductible

$1,250 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$100-400 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-10 copay
Lab services	$0-10 copay
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$50 copay

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Doctor Visits

Primary	$0 copay
Primary	30% coinsurance per visit (Out-of-Network)
Specialist	$30 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$120 copay per visit (always covered)
Urgent care	$30 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$30 copay
Foot exams and treatment	30% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$200 copay (Out-of-Network)
$200 copay

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$699-999 copay
Hearing aids	$699-999 copay (Out-of-Network)
Hearing exam	30% coinsurance (Out-of-Network)
Hearing exam	$0 copay

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Inpatient Hospital Coverage

$385 per day for days 1 through 6 $0 per day for days 7 through 90
30% per stay (Out-of-Network)

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

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

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MOOP

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

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$375 copay per visit
30% coinsurance per visit (Out-of-Network)

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Preventive Care

$0 copay
30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Cleaning	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	50% coinsurance (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)

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Skilled Nursing Facility

30% per stay (Out-of-Network)
$20 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

$0 copay (Out-of-Network)
$0 copay

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for MedMutual Advantage Premium (PPO) H4497

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in MedMutual Advantage Premium (PPO) Plans Performance

Health Plan Customer Service Rating for MedMutual Advantage Premium (PPO)

MedMutual Advantage Premium (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for MedMutual Advantage Premium (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.