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Mount Carmel MediGold Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold Premier (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 Premier (HMO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Premier (HMO) is a HMO 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 4.5 out of 5 stars in 2025.
It's important to know that Mount Carmel MediGold Premier (HMO) 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 Premier (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 Premier (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $107.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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
The Mount Carmel MediGold Premier (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $5 copay, while preferred brand drugs have a $75 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for all Part D drugs.
Additional Benefits
The Mount Carmel MediGold Premier (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services. You'll pay a copay for inpatient stays, with no copay after the fourth day. Outpatient services have varying copays, and emergency services have copays depending on the type of service. This plan also includes coverage for primary care, preventive, hearing, vision, and dental services. Many services, such as primary care visits, preventive services, and eyewear, have no copay. Other services, such as diagnostic, radiological services, and medical equipment, may have a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4, the copay is $190, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $175, observation services with no copay, ambulatory surgical center services with a $175 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Mount Carmel MediGold Premier (HMO) plan, with a $45 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mount Carmel MediGold Premier (HMO) plan. Ground ambulance services have a $200 copay, and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Mount Carmel MediGold Premier (HMO) plan. Emergency Services have a $90 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Services have a $90 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $200-$250 copay for Worldwide Emergency Transportation; all services have no coinsurance.
Primary Care See details
The Mount Carmel MediGold Premier (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and specialist services with a $30 copay. Mental health and psychiatric individual and group sessions have a $25 copay, physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay ranging from $0 to $30. Opioid treatment program services have a $25 copay, and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services. Additional preventive services include coverage for Fitness Benefit, Remote Access Technologies and Nursing Hotline with no copay. Other services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $399 and $699 for all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), and eyeglass lenses with no copay, and eyeglass frames with no copay. Upgrades are not covered.
Dental Services See details
Dental Services includes Medicare Dental Services with a $30 copay, and Other Dental Services with no copay. Restorative Services and Oral and Maxillofacial Surgery are covered with 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 Premier (HMO) 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, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and require authorization, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Mount Carmel MediGold Premier (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a $20 copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $85, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Mount Carmel MediGold Premier (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 not covered by the Mount Carmel MediGold Premier (HMO) plan. No copay or coinsurance information is available for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Mount Carmel MediGold Premier (HMO) plan. You will have no copay for days 1-20, a $214 copay for days 21-55, and no copay for days 56-100.
Other Services See details
The Mount Carmel MediGold Premier (HMO) plan covers acupuncture with a $20 copay, over-the-counter items with no copay, and a meal benefit with no copay. This plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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