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Mount Carmel MediGold Premium Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold Premium Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mount Carmel MediGold Premium Choice (PPO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Premium Choice (PPO) is a PPO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Central and Southwest Ohio. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Mount Carmel MediGold Premium Choice (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Mount Carmel MediGold Premium Choice (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Mount Carmel MediGold Premium Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Mount Carmel MediGold Premium Choice (PPO) plan has a $150 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you may pay a $5 copay for preferred generic drugs at a standard pharmacy, or a 25% coinsurance for standard generic drugs at standard and mail order pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Mount Carmel MediGold Premium Choice (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. Primary care visits have no copay, and preventive services are covered with no copay. The plan includes coverage for hearing, vision, and dental services with copays and coinsurance applying to some services. Ambulance, emergency, and diagnostic services have copays, and durable medical equipment and prosthetics have 20% coinsurance. Additionally, the plan covers home health services with no copay, and offers acupuncture and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Mount Carmel MediGold Premium Choice (PPO) plan. For Inpatient Hospital-Acute, there is a $395 copay for days 1-5, and no copay for days 6-90; and for Inpatient Hospital Psychiatric, there is a $395 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $10-$325, observation services with no copay, ambulatory surgical center services with a $325 copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mount Carmel MediGold Premium Choice (PPO) plan. Ground ambulance services have a $275 copay, and air ambulance services have a $325 copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Mount Carmel MediGold Premium Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $275-$325 copay, with no coinsurance for any of these services.
Primary Care See details
The Mount Carmel MediGold Premium Choice (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay, and physician specialist services have a $40 copay. Mental health, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and telehealth services have a copay between $0 and $40.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar services and an annual physical exam with no copay. Additional preventive services, including fitness benefits, and remote access technologies, are covered with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Mount Carmel MediGold Premium Choice (PPO) plan covers vision services, including eye exams with a copay of $0-$40 and eyewear with no copay, and a combined maximum benefit of $150 per year for both in-network and out-of-network services. Routine eye exams have no copay for one visit per year, while upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, and no copay for other dental services. Restorative services and oral and maxillofacial surgery have a 50% coinsurance, while endodontics and periodontics have a 70% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Mount Carmel MediGold Premium Choice (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Mount Carmel MediGold Premium Choice (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered services. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $60 copay, lab services with a $10 copay, and outpatient X-ray services with a $50 copay. Diagnostic Radiological Services have a copay of at least $225, and Therapeutic Radiological Services have a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Mount Carmel MediGold Premium Choice (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Mount Carmel MediGold Premium Choice (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, with no copay for days 1-20 and days 56-100, and a $214 copay for days 21-55. Additional and non-Medicare-covered SNF days are not covered.
Other Services See details
The Mount Carmel MediGold Premium Choice (PPO) plan covers acupuncture with a $20 copay per visit, but is limited to 6 treatments per year and requires prior authorization. Over-the-counter items are covered with no copay, up to a maximum of $105 every three months, and the plan offers nicotine replacement therapy and Naloxone. The plan also covers a meal benefit with no copay for a chronic illness. Several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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