Paramount Elite Essential (HMO-POS) 2025 Plan Details for Warren County, Ohio Residents
Paramount Elite Essential (HMO-POS) 2025 Plan Details for Warren County, Ohio Residents
Navigating your Medicare Advantage options in Warren County for 2025 can be overwhelming, but we're here to help. With Paramount Elite Essential (HMO-POS) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 96 Medicare beneficiaries are enrolled in this plan, with 12 members in Warren County, OH.
Paramount Elite Essential Overview
| Plan ID H3653-024-0 Overview | |
|---|---|
| Health Plan ID: | H3653-024-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3,100.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Warren County, OH |
| Insured By: | Paramount Elite Medicare Plans |
Why Choose Paramount Elite Essential ?
This Medicare Advantage MAPD HMO-POS plan offers both structure and flexibility — including hospital, medical, and prescription drug coverage. With a monthly premium of $0.00, it covers Medicare Part A and Part B benefits, along with built-in drug coverage to help manage ongoing prescriptions. The annual Part D deductible is $0.00. You can get care in or out of network, but you’ll usually pay less when sticking with in-network providers.
Primary care visits have a $0 copay, specialist visits come with a $35 copay, urgent care services carry a $35 copay, and ambulance transportation is $300 copay. These costs apply toward the plan’s maximum out-of-pocket (MOOP) limit of $3,100.00 . Once that limit is reached, your in-network healthcare is covered at 100% for the rest of the year.
You’ll find this plan listed by CMS as H3653-024-0. A cost-sharing summary appears below with details on what you’ll pay for common services. Still have questions? Check the FAQ section for more answers.
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Cost-Sharing Overview
Paramount Elite Essential has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H3653-024-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $35 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $135 Copay |
| Urgent care: | $35 Copay |
| Ground ambulance: | $300 Copay |
| Inpatient hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $200.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $35 Copay |
| Routine Foot Care: | $10 Copay |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $35 Copay |
| Outpatient group therapy: | $35 Copay |
| Inpatient psychiatric hospital care: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $35 Copay Prior Authorization Required |
| Occupational therapy: | $35 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $150 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | $50 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $20 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 0% Coinsurance Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $35 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $200.00 Every year |
Certain preventive services are covered 100% by Paramount Elite Essential as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Paramount Elite Essential includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $(12.40) |
|---|---|
| Supplemental Part D Premium: | $12.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Paramount Elite Medicare Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Paramount Elite Essential may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $0.00 | $0.00 |
| Preferred Brand | $45.00 | $45.00 |
| Non-Preferred Drug | $100.00 | $100.00 |
| Specialty Tier | 33.00% | 0.00% |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Paramount Elite Essential ?
You are eligible to enroll in Paramount Elite Essential if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Paramount Elite Essential and take advantage of its full range of benefits.
When Can I Enroll in Paramount Elite Essential ?
To ensure you don’t miss your chance to enroll in Paramount Elite Essential , be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for Paramount Elite Essential
Getting started with Paramount Elite Essential is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Paramount Elite Essential . The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H3653-024-0:
How much does H3653-024-0 cost per month?
The 2025 premium is $0.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $3,100.00 , protecting you from larger bills once you hit that limit.
What’s the prescription-drug deductible for 2025?
Yes. The Part D deductible is $0.00. The plan does not have a drug tier without a deductible.
Is this a 4-star or 5-star plan?
CMS rates it ★4.0 out of 5 stars for 2025.
How many members does Paramount Elite Essential have?
Enrollment stands at roughly 96 members.
Contact Paramount Elite Medicare Plans
| Website: | Paramount Elite Medicare Plans Plan Page |
|---|---|
| Providers: | Paramount Elite Medicare Plans Providers Page |
| Formulary: | Paramount Elite Medicare Plans Formulary Page |
| Pharmacy: | Paramount Elite Medicare Plans Pharmacy Page |
| New Member Health Plan Help: | (855)508-2526 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (855)508-2526 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Paramount Elite Medicare Plans, http://paramounthealthcare.com/medicareplans, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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