A non-government entity
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 2026, 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 2026.
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 $102.00. 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:
Sign up for Mount Carmel MediGold Premier (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Mount Carmel MediGold Premier (HMO) plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. For Tier 1 preferred generic drugs, there is no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are also available with no copay through standard mail order, or you can pay a low copay starting at $5 for a one-month supply at a standard pharmacy. For higher-tier medications, the plan transitions to coinsurance for cost sharing. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 40% coinsurance for both standard pharmacy and standard mail order options. Tier 5 specialty medications carry a 33% coinsurance for a one-month supply.
Additional Benefits
The Mount Carmel MediGold Premier (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care doctor visits and home health services. Specialist visits require a $30 copay, while inpatient hospital stays cost a $190 daily copay for the first four days followed by no copay for the remaining covered days. Outpatient services are also highly accessible, featuring no coinsurance and copays ranging from no copay up to $175 depending on the service. This plan also includes valuable everyday benefits, such as preventive dental care and annual vision exams with eyewear covered at no copay. Routine hearing exams are provided with no copay, while prescription hearing aids require a copay between $399 and $699. Additionally, members can take advantage of covered preventive services with no copay, free meal benefits, and an over-the-counter allowance of up to $125 every three months.
Inpatient Hospital See details
Mount Carmel MediGold Premier (HMO) covers inpatient hospital acute and psychiatric stays with no coinsurance, requiring prior authorization and a $190 daily copay for days 1 through 4, with no copay for days 5 through 90. Unlimited additional acute care days are covered with no copay, though room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Mount Carmel MediGold Premier (HMO) with no coinsurance for all services, featuring copays ranging from $0 to $175 for outpatient hospital services and $180 per stay for observation services. Ambulatory surgical center services have a $175 copay, outpatient substance abuse sessions carry a $25 copay, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Mount Carmel MediGold Premier (HMO) covers partial hospitalization services with a $45.00 copayment and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Mount Carmel MediGold Premier (HMO) plan, featuring a $200 copay for ground ambulance and a $250 copay for air ambulance, with no coinsurance for either. Transportation services are partially covered with no copay or coinsurance for unlimited round trips to plan-approved locations, but stretcher rides and trips to any health-related locations are not covered.
Emergency Services See details
Mount Carmel MediGold Premier (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency services, urgent care, and emergency transportation are covered with copays ranging from $130 to $250 and no coinsurance.
Primary Care See details
Mount Carmel MediGold Premier (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, speech, and occupational therapies require a $35 copay and no coinsurance, while mental health, psychiatric, and opioid treatment sessions have a $25 copay and no coinsurance. Podiatry is not covered, and chiropractic services are technically covered though routine and other chiropractic sub-services are excluded.
Preventive Services See details
Preventive Services are partially covered by Mount Carmel MediGold Premier (HMO) with no copay and no coinsurance for covered services such as annual physical exams, fitness benefits, and remote access technologies. However, several supplemental options are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Mount Carmel MediGold Premier (HMO) offers hearing services with no deductible, featuring Medicare-covered exams for a $30 copay and routine exams or fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $699 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Mount Carmel MediGold Premier (HMO) offers partially covered vision services with no coinsurance, which includes one routine eye exam per year and eyewear (such as contacts, lenses, and frames) with no copay. Other eye exam services and eyewear upgrades are not covered, and covered eyewear is subject to a combined annual maximum benefit of $275.
Dental Services See details
Mount Carmel MediGold Premier (HMO) dental services are partially covered, offering Medicare-covered dental for a $30 copay and no coinsurance, and preventive care with no copay or coinsurance up to a $1,000 yearly limit. Comprehensive services require no copay with coinsurance ranging from 50% to 70%, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Mount Carmel MediGold Premier (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Mount Carmel MediGold Premier (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold Premier (HMO) covers durable medical equipment (DME), 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 carry a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Mount Carmel MediGold Premier (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $20 copay under prior authorization. Covered radiological services include outpatient X-rays for a $20 copay with coinsurance, diagnostic radiology starting at an $85 copay with no coinsurance, and therapeutic radiology which requires a 20% coinsurance and a copay.
Home Health Services See details
Mount Carmel MediGold Premier (HMO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Mount Carmel MediGold Premier (HMO) with no coinsurance, though only some services are covered as standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Mount Carmel MediGold Premier (HMO) with no coinsurance, featuring no copay for days 1 to 20 and 61 to 100, and a $218 daily copay for days 21 to 60. Prior three-day inpatient hospital stays are not required for admission, but additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services covered under the Mount Carmel MediGold Premier (HMO) include acupuncture for a $20 copay and no coinsurance, as well as meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is limited to 12 treatments per year and requires prior authorization, while the OTC benefit provides up to $125 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved