Mount Carmel MediGold Premium Choice (PPO)

Mount Carmel MediGold Premium Choice (PPO) is a PPO plan offered by Mount Carmel Health Insurance Company available for the 2026 plan year to people living in Central and Southwest Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.

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.

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:

Drug Coverage

The Mount Carmel MediGold Premium Choice (PPO) plan features an annual drug deductible of $200 before coverage begins. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a low copay starting at $5 at standard pharmacies, but they feature no copay when filled through standard mail order. For brand-name and specialty prescriptions, costs are based on coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance for both standard retail and mail-order fills. Tier 5 specialty drugs are limited to a one-month supply and require a 30% coinsurance.

Additional Benefits

The Mount Carmel MediGold Premium Choice (PPO) plan offers robust medical coverage with no copay for primary care visits and routine preventive services. For specialized care, members pay a $40 copay for specialist visits, a $130 copay for emergency room care, and a $395 daily copay for the first five days of inpatient hospital stays. Outpatient hospital services feature copays ranging from $10 to $350, with no coinsurance required for these core medical services. This plan also includes valuable supplemental benefits, including no copay for routine annual vision and hearing exams, plus a $1,000 annual limit for preventive dental care with no copay. While home health services are covered with no copay, durable medical equipment and dialysis services require a 20% coinsurance. Additionally, members can access covered skilled nursing facility stays with no copay for days 1 through 20 and days 61 through 100.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.