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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 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)
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Drug Coverage
The Mount Carmel MediGold Premier (HMO) plan features a $0 prescription drug deductible, allowing your coverage to begin immediately. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs also feature no copay for mail order prescriptions, while standard retail pharmacy copays range from $5 for a one-month supply up to $15 for a three-month supply. For brand-name and specialty medications, costs are structured as coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty medications in Tier 5 are available with a 33% coinsurance for a one-month supply.
Additional Benefits
The Mount Carmel MediGold Premier (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits and a $30 copay for specialists. For hospital stays, members pay a $190 daily copay for the first four days of inpatient acute care and no copay for days five through 90. Outpatient services, diagnostic lab tests, and home health services are also highly accessible with no copays and no coinsurance. This plan includes valuable extra benefits like routine vision and preventive dental care with no copay, alongside an annual eyewear allowance of $275 and a dental limit of $1,000. Additionally, members can take advantage of hearing aids with copays starting at $399, a quarterly $125 over-the-counter item allowance, and unlimited transportation to approved locations with no copay. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 48 hours.
Inpatient Hospital See details
Mount Carmel MediGold Premier (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $190 daily copay for days 1 through 4 and no copay for days 5 through 90. Additional acute stay days are unlimited with no copay, though psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Mount Carmel MediGold Premier (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital copays from $0 to $175, a $180 per-stay copay for observation services, and a $175 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Mount Carmel MediGold Premier (HMO) plan with a $45.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Mount Carmel MediGold Premier (HMO), with ground ambulance services requiring a $200 copay and air ambulance services requiring a $250 copay, both with no coinsurance. Transportation services are partially covered, offering unlimited round trips to plan-approved locations with no copay or coinsurance, while stretcher rides and transport to any health-related location are not covered.
Emergency Services See details
Mount Carmel MediGold Premier (HMO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered with a $130 copay, while worldwide emergency transportation has a copay of $200 to $250, all with 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, occupational, and speech therapy services require a $35 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Mount Carmel MediGold Premier (HMO) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, fitness benefits, and remote access technologies. The plan does not cover 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/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
Mount Carmel MediGold Premier (HMO) covers hearing exams with a $30 copay for Medicare-covered exams and no copay for annual routine exams or fitting evaluations, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $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) partially covers vision services with no deductible, no coinsurance, and no copay for covered services, which include one routine eye exam per year and eyewear up to a $275 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Mount Carmel MediGold Premier (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance up to a $1,000 annual limit, while Medicare-covered dental services require a $30 copay and no coinsurance. Covered comprehensive services have no copay and coinsurance ranging from 0% to 70%, but 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 and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Mount Carmel MediGold Premier (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold Premier (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts are covered with a copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Mount Carmel MediGold Premier (HMO) covers diagnostic and radiological services, offering lab services with no copay and no coinsurance, and diagnostic procedures or outpatient X-rays for a $20 copay. Diagnostic radiological services require a minimum copay of $85, therapeutic radiological services carry a 20% coinsurance, and prior authorization is required for diagnostic services.
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
Mount Carmel MediGold Premier (HMO) offers cardiac rehabilitation services with no coinsurance, although only some services are covered in practice. Cardiac rehabilitation and intensive cardiac rehabilitation services are not covered and require a $30 copay, while pulmonary rehabilitation and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are also not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold Premier (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 61 to 100, while days 21 to 60 require a $218 daily copay, with no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Mount Carmel MediGold Premier (HMO) covers acupuncture with a $20 copay, no coinsurance, and a limit of 12 treatments per year requiring prior authorization. Over-the-counter (OTC) items up to $125 every three months and meal benefits for chronic illnesses are both covered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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