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Mount Carmel MediGold Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold 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 Choice (PPO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Choice (PPO) is a PPO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Northwest Ohio. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Mount Carmel MediGold 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 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 Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $15.30. You must continue to pay paying your reduced 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 Choice (PPO) plan has a $150 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, you may pay a $10 copay for a standard generic drug, or 25% coinsurance for a standard generic drug. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, this plan's premium may be reduced.
Additional Benefits
The Mount Carmel MediGold Choice (PPO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays for specific services. Primary care, preventive, vision, dental, and hearing services are covered with copays, and also include no copay options. The plan also covers ambulance, emergency, and home health services, and provides coverage for medical equipment and diagnostic services with copays or coinsurance. Additional benefits include coverage for skilled nursing facilities, home infusion, and dialysis services. The plan also covers outpatient services, partial hospitalization, and offers other services like acupuncture and over-the-counter items. However, services like cardiac rehabilitation and certain types of vision and dental services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $375 copay for days 1-4, and no copay for days 5-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $375 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $15-$275, observation services with no copay, ambulatory surgical center services with a $275 copay, and outpatient substance abuse services with a $40 copay per individual or group session. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Mount Carmel MediGold Choice (PPO) plan, with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mount Carmel MediGold Choice (PPO) plan. Medicare-covered ground ambulance services have a $250 copay, and air ambulance services have a $300 copay, but there is no coinsurance. 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 Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a $250-$300 copay; all have no coinsurance.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (routine care not covered), a $40 copay for Occupational Therapy Services, a $35 copay for Physician Specialist Services, and a $40 copay for both Individual and Group Sessions for Mental Health Specialty Services. Podiatry Services are not covered, and Other Health Care Professional services have a copay between $0 and $35. Psychiatric Services and Opioid Treatment Program Services have a $40 copay for both Individual and Group Sessions, and Physical Therapy and Speech-Language Pathology Services have a $40 copay with no coinsurance. Additional Telehealth Benefits have a copay between $0 and $40.
Preventive Services See details
The Mount Carmel MediGold Choice (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Mount Carmel MediGold Choice (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with a combined maximum benefit of $150 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, but upgrades are not covered.
Dental Services See details
The Mount Carmel MediGold Choice (PPO) plan covers dental services, including Medicare dental services with a $35 copay, and other dental services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, while Endodontics and Periodontics have a 70% coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Mount Carmel MediGold Choice (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Mount Carmel MediGold Choice (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services. Diagnostic procedures/tests have a $25 copay, lab services have a $15 copay, diagnostic radiological services have a $180 copay, therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Mount Carmel MediGold 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 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 the Mount Carmel MediGold Choice (PPO) plan. For days 1-20 and 56-100, there is no copay, but for days 21-55, the copay is $214.
Other Services See details
Other Services includes acupuncture, over-the-counter items, and a meal benefit. Acupuncture has a $20 copay for up to 6 treatments per year, while over-the-counter items have no copay with a maximum benefit of $105 every three months, and the meal benefit has no copay. Several other services are not covered.
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