A non-government entity
Mount Carmel MediGold No Premium (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold No Premium (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 No Premium (HMO) in 2026, please refer to our full plan details page.
Mount Carmel MediGold No Premium (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 No Premium (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 No Premium (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 No Premium (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 $2.00. 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 $150.00 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 Maximum Out-Of-Pocket cost of $4900.00 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 No Premium (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 No Premium (HMO) prescription drug plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and standard mail order. Tier 2 generic drugs cost between a $5 and $15 copay at standard pharmacies, but they feature no copay when filled through standard mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 45% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs require a 31% coinsurance for a one-month supply.
Additional Benefits
The Mount Carmel MediGold No Premium (HMO) plan offers comprehensive coverage for essential medical services with predictable copays and no coinsurance for most care. Members benefit from no copay for primary care visits and preventive services, while specialist visits and outpatient mental health services require a $35 copay. For hospital stays, inpatient care requires a $325 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $130 copay. This plan also includes valuable extra benefits, such as routine dental, vision, and hearing exams with no copays, alongside allowances for prescription hearing aids and eyewear. Other key services like home health care and unlimited transportation to plan-approved locations are covered with no copay, and members receive a $100 quarterly allowance for over-the-counter items. Additionally, skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by Mount Carmel MediGold No Premium (HMO) with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. Prior authorization is required, and while acute care includes unlimited additional days at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Mount Carmel MediGold No Premium (HMO) feature no coinsurance, with copays ranging from $0 to $270 for outpatient hospital services and $315 per stay for observation services. Ambulatory surgical center services require a $270 copay, outpatient substance abuse sessions have a $35 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Mount Carmel MediGold No Premium (HMO) plan with a $50 copay and no coinsurance. This coverage ensures affordable access to intensive outpatient mental health services with predictable out-of-pocket costs.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Mount Carmel MediGold No Premium (HMO), featuring a $250 copay for ground ambulance and a $300 copay for air ambulance, with no coinsurance required for either service. Transportation services are partially covered, offering unlimited round trips to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Mount Carmel MediGold No Premium (HMO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and urgently needed services with a $45 copay, both with no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, while worldwide emergency transportation has a copay of $250 to $300, all with no coinsurance.
Primary Care See details
Mount Carmel MediGold No Premium (HMO) offers primary care and select telehealth services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $40 copay and no coinsurance, podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Mount Carmel MediGold No Premium (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness benefits and remote access technologies with no copay or coinsurance, though sub-services like health education, in-home safety assessments, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Mount Carmel MediGold No Premium (HMO) covers hearing services with a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine annual exams and fitting evaluations. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance for up to two devices per year, but over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Mount Carmel MediGold No Premium (HMO), offering no copay and no coinsurance for annual routine eye exams and eyewear up to a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Mount Carmel MediGold No Premium (HMO) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, preventive services have no copay and no coinsurance up to a $1,000 annual limit, and other covered comprehensive services require no copay with 0% to 70% coinsurance.
Home Infusion bundled Services See details
Mount Carmel MediGold No Premium (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay, no coinsurance, and no deductible, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Mount Carmel MediGold No Premium (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold No Premium (HMO) covers medical equipment, featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Mount Carmel MediGold No Premium (HMO) covers diagnostic and radiological services, with lab services available at no copay and no coinsurance. Diagnostic tests and outpatient X-rays both require a $50 copay, while diagnostic radiological services have a minimum $210 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Mount Carmel MediGold No Premium (HMO) provides full coverage for home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Mount Carmel MediGold No Premium (HMO) does not cover cardiac rehabilitation services, despite technically listing no coinsurance. In practice, none of the sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET)—are covered, meaning there is no copay or coinsurance coverage available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Mount Carmel MediGold No Premium (HMO) with no coinsurance and no prior three-day inpatient hospital stay required. Patients pay no copay for days 1 through 20 and days 61 through 100, but a $218 copay applies for days 21 through 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Mount Carmel MediGold No Premium (HMO) covers other services including acupuncture with a $20 copay and no coinsurance, limited to 6 treatments per year with prior authorization. Over-the-counter items up to $100 every three months and a chronic illness meal benefit are also 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
*/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