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 2025, 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 2025.
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 $13.20. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy type. For example, you will pay a $5 copay at a standard pharmacy for tier 1 drugs. For tier 1 drugs purchased via mail order, there is no copay. For tier 2 and 3 drugs, you will pay 25% or 50% coinsurance, respectively. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Mount Carmel MediGold No Premium (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $325 copay for days 1-5, with no copay for subsequent days. Outpatient services have copays ranging from $0 to $270, and primary care visits have no copay. Preventive services, including annual checkups, have no copay, while hearing and vision services have copays for exams and eyewear. Dental services include copays and coinsurance for certain procedures. The plan also covers home health services with no copay and offers coverage for ambulance, emergency, and other services with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $270, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $270 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $35 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Mount Carmel MediGold No Premium (HMO) plan. You will have a $50 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Mount Carmel MediGold No Premium (HMO). Ground ambulance services have a $250 copay, while air ambulance services have a $300 copay; there is no coinsurance for either. Transportation services to plan-approved health-related locations have no copay, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Mount Carmel MediGold No Premium (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $250-$300 copay.
Primary Care See details
The Mount Carmel MediGold No Premium (HMO) plan covers primary care physician services with no copay. Chiropractic services require a $20 copay, but routine care is not covered. Occupational therapy services have a $40 copay, and physician specialist services have a $35 copay. Mental health and psychiatric services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, while additional telehealth benefits range from no copay to a $35 copay. Opioid treatment program services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, with no copay, as well as an annual physical exam with no copay. Additional preventive services, like glaucoma screenings and diabetes self-management training, are covered with a $0 copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $599 and $899, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Mount Carmel MediGold No Premium (HMO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with a maximum plan benefit of $200 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $35 copay, and other dental services with no copay. Restorative Services and Oral and Maxillofacial Surgery have 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 by the Mount Carmel MediGold No Premium (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. You will pay 20% coinsurance for Durable Medical Equipment, Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, and Diabetic Therapeutic Shoes/Inserts. There is no copay for these services. Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Mount Carmel MediGold No Premium (HMO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a $50 copay, Lab Services with no copay, and Outpatient X-Ray Services with a $50 copay. Diagnostic Radiological Services have a copay of at least $180, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Mount Carmel MediGold No Premium (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, but the plan does not cover 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. The plan has a copay for services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Mount Carmel MediGold No Premium (HMO) plan. There is no copay for days 1-20 and days 56-100, and a $214 copay for days 21-55.
Other Services See details
The Mount Carmel MediGold No Premium (HMO) plan covers acupuncture with a $20 copay, up to 6 treatments per year with prior authorization. Over-the-counter items are covered with no copay, up to $110 every three months, and includes nicotine replacement therapy and Naloxone. Meal benefits are covered with no copay for a chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more, are not covered.
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