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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 2026, 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 2026.
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 $7.00. 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 $200.00 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) Medicare plan features an annual drug deductible of $200. Under this plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs also feature no copay when filled via standard mail order, while standard pharmacy fills require a copay of $5 for one month, $10 for two months, or $15 for three months. For higher-tier medications, costs transition to a coinsurance percentage for both standard pharmacy and standard mail order fills. Tier 3 preferred brands carry a 25% coinsurance, Tier 4 non-preferred drugs carry a 40% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. This clear cost-sharing structure helps you easily estimate your out-of-pocket prescription costs under this PPO plan.
Additional Benefits
The Mount Carmel MediGold Choice (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, members pay a $35 copay, while inpatient hospital stays require a $395 daily copay for the first five days and no copay for days six through ninety. Emergency services are covered with a $130 copay, which is waived if admitted, and urgent care visits require a $40 copay. In addition to core medical care, this plan provides valuable supplemental benefits including routine dental preventive care and routine hearing exams with no copay. Vision services include eye exams with copays ranging from no copay to $35 alongside a $150 annual allowance for eyewear. Members also benefit from a $75 quarterly allowance for over-the-counter items with no copay and acupuncture coverage at a $20 copay per visit.
Inpatient Hospital See details
Mount Carmel MediGold Choice (PPO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Mount Carmel MediGold Choice (PPO) covers outpatient services with no coinsurance, including outpatient hospital copays from $15.00 to $375.00, observation services at a $385.00 copay per stay, and ambulatory surgical center services at a $375.00 copay. Outpatient substance abuse sessions require a $40.00 copay with no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Mount Carmel MediGold Choice (PPO) covers partial hospitalization services. Members will pay a $50.00 copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
Mount Carmel MediGold Choice (PPO) covers emergency ambulance services with no coinsurance, requiring a $250 copay for ground transport and a $300 copay for air transport, with prior authorization required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Mount Carmel MediGold Choice (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have a $40 copay with no coinsurance, while worldwide emergency and transportation services are covered with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Mount Carmel MediGold Choice (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay with no coinsurance. Additional services like mental health, psychiatric, and physical therapies carry a $40 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Mount Carmel MediGold Choice (PPO) with no copay and no coinsurance, including annual physicals, fitness benefits, and remote access technologies. However, additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Mount Carmel MediGold Choice (PPO) covers hearing services with no coinsurance, offering routine hearing exams and fitting evaluations for no copay, and Medicare-covered exams for a $35 copay. Prescription hearing aids are partially covered with copays ranging from $599 to $899 and no coinsurance, while over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Mount Carmel MediGold Choice (PPO) with no deductibles or coinsurance, featuring eye exams with a $0 to $35 copay and eyewear up to a $150 annual maximum with no copay. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Mount Carmel MediGold Choice (PPO), featuring preventive care with no copay and no coinsurance up to a $1,000 annual limit, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive benefits like restorative care and oral surgery have no copay and 50% coinsurance, while endodontics and periodontics have no copay and 70% coinsurance; however, orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Mount Carmel MediGold Choice (PPO) with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Mount Carmel MediGold Choice (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold Choice (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Mount Carmel MediGold Choice (PPO), featuring a $15 copay with no coinsurance for lab services and a $25 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services require a minimum $225 copay with no coinsurance, while outpatient X-rays have a $20 copay with coinsurance, and therapeutic radiological services require a minimum 20% coinsurance plus a copay.
Home Health Services See details
Home health services are covered by Mount Carmel MediGold Choice (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Mount Carmel MediGold Choice (PPO) with no coinsurance, though only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered. When utilized, these services require a copayment of $15 for pulmonary and SET for PAD, and $30 for cardiac and intensive cardiac rehabilitation.
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold Choice (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Admission does not require a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Mount Carmel MediGold Choice (PPO) covers acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter benefits are capped at $75 every three months, while other unspecified additional services are not covered.
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