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Mount Carmel MediGold Glory No RX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold Glory No RX (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mount Carmel MediGold Glory No RX (HMO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Glory No RX (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Central, Southwest, and Northwest Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Mount Carmel MediGold Glory No RX (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Mount Carmel MediGold Glory No RX (HMO).
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 Glory No RX (HMO), 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 $100.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
Prescription drugs are not covered by Mount Carmel MediGold Glory No RX (HMO).
Additional Benefits
The Mount Carmel MediGold Glory No RX (HMO) plan offers comprehensive coverage with a focus on outpatient and preventive care. This plan includes no copay for primary care visits, many preventive services, vision services like eyewear, and home health services. It also provides coverage for hearing exams, dental services, and various therapies with copays ranging from $20 to $30. For inpatient hospital stays, you'll have a $95 copay for the initial days, with no copay for the remaining days. The plan also covers emergency services, ambulance services, and offers benefits for home infusion, dialysis, and medical equipment with varying copays, coinsurance, and coverage limitations. Additionally, this plan includes benefits like acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $95 copay for days 1-7, and no copay for days 8-90, while Additional Days are unlimited with no copay, and Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $95 copay for days 1-7 and no copay for days 8-90, while Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $175, observation services with no copay, ambulatory surgical center services with a $175 copay, individual and group sessions for outpatient substance abuse with a copay of $25, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $30 copay.
Ambulance and Transportation Services See details
The Mount Carmel MediGold Glory No RX (HMO) plan covers ambulance and transportation services. Ground ambulance services have a $200 copay, while air ambulance services have a $250 copay, and transportation services to a plan-approved health-related location have no copay. 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 under the Mount Carmel MediGold Glory No RX (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, and Worldwide Emergency Transportation has a copay between $200 and $250.
Primary Care See details
The Mount Carmel MediGold Glory No RX (HMO) plan covers primary care physician services with no copay and specialist services with a $30 copay. Chiropractic services have a $20 copay, and occupational therapy services, mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay. Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits range from no copay to a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services. Additional preventive services have a copay, as do the fitness benefit, and remote access technologies. Kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $30 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $599 and $899, and OTC hearing aids are not covered. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The Mount Carmel MediGold Glory No RX (HMO) plan covers vision services, including eye exams with a copay of $0-$30 and eyewear with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and Other Dental Services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, 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 with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Mount Carmel MediGold Glory No RX (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, with no copay for Diabetic Supplies and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $25 copay, and lab services with no copay. Diagnostic radiological services have a copay of at least $95, while therapeutic radiological services have at least 20% coinsurance. Outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered under the Mount Carmel MediGold Glory No RX (HMO) 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 covered by the Mount Carmel MediGold Glory No RX (HMO) plan, however, all sub-services are not covered. 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 Glory No RX (HMO) plan. There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55.
Other Services See details
The Mount Carmel MediGold Glory No RX (HMO) plan covers acupuncture with a $20 copay for up to 6 treatments per year, and covers over-the-counter items with no copay, up to $75 every three months. Additionally, this plan covers a meal benefit with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services.
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