2019 MedMutual Advantage Select (PPO) H4497-1-1 in OH from Medical Mutual | HealthPocket

MedMutual Advantage Select (PPO)

$38/mo

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Zip Code43228
Applicant8/23/1984 Male
Coverage Start8/24/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderMedical Mutual
Plan IDH4497-1-1
Plan Year2019
CMS Rating
Plan TypePPO
Annual Deductible$160.00

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$38.00
Health Plan Deductible$2,000 annual deductible
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,500 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$360 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:30% per stay
Outpatient hospital coverageIn-Network:$375 per visit
Out-of-Network:30% per visit
Doctor visitsPrimary:
In-Network:$10 per visit
Out-of-Network:30% per visit
Specialist:
In-Network:$45 per visit
Out-of-Network:30% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:30%
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$45 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0-10
Out-of-Network:30%
Lab services:
In-Network:$0-10
Out-of-Network:30%
Diagnostic radiology services (e.g., MRI):
In-Network:$100-350
Out-of-Network:30%
Outpatient x-rays:
In-Network:$50
Out-of-Network:30%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$330 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:30%
Outpatient group therapy visit:
In-Network:$40
Out-of-Network:30%
Outpatient individual therapy visit:
In-Network:$40
Out-of-Network:30%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network:30% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:$40
Out-of-Network:30%
Physical therapy and speech and language therapy visit:
In-Network:$40
Out-of-Network:30%
Ground ambulanceIn-Network:$200
Out-of-Network:$200
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$45
Out-of-Network:30%
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:20% per item
Out-of-Network:30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:20% per item
Out-of-Network:30% per item
Diabetes supplies:
In-Network:0-20% per item
Out-of-Network:20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:20%
Other Part B drugs:
In-Network:20%
Out-of-Network:20%

Benefits Services

Hearing
Hearing examIn-Network: $0 copay
Out-of-Network: 30%
Fitting/evaluationNot covered
Hearing aidsIn-Network: $699-999
Out-of-Network: $699-999
There may be limits on how much the plan will provide.
Preventive Dental
Oral examIn-Network: $0 copay
Out-of-Network: 50%
There may be limits on how much the plan will provide.
CleaningIn-Network: $0 copay
Out-of-Network: 50%
There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)In-Network: $0 copay
Out-of-Network: 50%
There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: $50
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for MedMutual Advantage Select (PPO)

StateOhio
CountyFranklin

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$8 copayNot offered
Tier 2: Non-Preferred Generic$15 copay$20 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offered
Tier 5: Specialty Tier30% coinsurance30% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$16 copayNot offered
Tier 2: Non-Preferred Generic$38 copay$50 copayNot offered
Tier 3: Preferred Brand Name$118 copay$132 copayNot offered
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate
Statin Use in Persons with Diabetes

Physicians that accept MedMutual Advantage Select (PPO) for Ohio

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Paul, Harris
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Matthew, Brown
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John, Hinckley
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Brian, Moon
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Huma, Naikoo
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Rajitha, Dasari
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Victoria, Famuyide
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Vicki, Sherman
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Tricia, Honeycutt
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Jillian, Kurtz
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Andrew, Petersen
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Joshua, Botteicher
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Genevieve, Co Faustino
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Warren, Reiss
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John, Casey
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Nathan, Lott
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John, Parker
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Hetul, Patel
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Leigh, Hughey
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Joseph, Levinson
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Sarah, Parker
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Gaurav, Mehta
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Mariusz, Rybaltowski
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Caren, Miller
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Paul Harris, D.O.
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  • Phone Number
    (614) 878-6455
  • Office Locations
    15 Norton Rd
    Columbus, OH 43228
15 Norton Rd Columbus OH, 43228
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)