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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 $19.20. 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 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)
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Drug Coverage
The Mount Carmel MediGold No Premium (HMO) plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs also have no copay when ordered through standard mail order, while standard pharmacy fills cost a $5 copay for one month, $10 for two months, and $15 for three months. For brand-name and specialty medications, costs transition to coinsurance percentages. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 45% coinsurance for standard pharmacy and mail order fills. Tier 5 specialty drugs require a 31% coinsurance for a one-month supply under both standard pharmacy and standard mail order options.
Additional Benefits
The Mount Carmel MediGold No Premium (HMO) offers affordable healthcare coverage with no copay for primary care visits, telehealth, and routine preventive services. For inpatient hospital stays, members pay a $325 daily copay for days one through five, followed by no copay for days six through 90. Specialist visits require a $35 copay, while emergency room services carry a $110 copay that is waived if you are admitted within 48 hours. This plan also includes valuable extra benefits, such as no copay for routine dental, vision, and hearing exams, plus a $200 annual eyewear allowance and up to $1,000 in dental coverage. Members benefit from unlimited transportation to plan-approved locations at no cost and a $125 quarterly over-the-counter item allowance. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Mount Carmel MediGold No Premium (HMO) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and the benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Mount Carmel MediGold No Premium (HMO) are covered with no coinsurance, featuring outpatient hospital copays ranging from $0 to $265 and observation services at a $315 copay per stay. Ambulatory surgical center services require a $265 copay with no coinsurance, outpatient substance abuse sessions carry a $35 copay, and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Mount Carmel MediGold No Premium (HMO) plan with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Mount Carmel MediGold No Premium (HMO) covers ambulance services with no coinsurance and a copay of $250 for ground transport and $300 for air transport. Transportation services are partially covered with no copay and no coinsurance for unlimited round trips to plan-approved locations, but stretcher rides and trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the Mount Carmel MediGold No Premium (HMO) with a $110 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $45 copay with no coinsurance, while worldwide emergency and urgent care are covered with a $110 copay, and worldwide emergency transportation has a copay of $250 to $300, all with no coinsurance.
Primary Care See details
Mount Carmel MediGold No Premium (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist, psychiatric, mental health, and opioid treatment services carry a $35 copay and no coinsurance. Physical, occupational, and speech therapy require a $40 copay with no coinsurance, podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Mount Carmel MediGold No Premium (HMO) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, fitness benefits, and kidney disease education. However, several supplemental services are not covered under this plan, such as health education, weight management programs, personal emergency response systems (PERS), and nutritional or dietary benefits.
Hearing Services See details
Hearing services covered by Mount Carmel MediGold No Premium (HMO) include Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two aids per year, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Mount Carmel MediGold No Premium (HMO) provides partially covered vision services with no coinsurance, offering no copay for one routine eye exam per year and no copay for eyewear up to a $200 annual limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Mount Carmel MediGold No Premium (HMO) up to a $1,000 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while preventive services like cleanings and exams feature no copay and no coinsurance. Comprehensive services, such as restorative care, endodontics, periodontics, and oral surgery, require no copay but have coinsurance ranging from 50% to 70%.
Home Infusion bundled Services See details
Mount Carmel MediGold No Premium (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Mount Carmel MediGold No Premium (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold No Premium (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Mount Carmel MediGold No Premium (HMO), offering lab services with no copay or coinsurance and outpatient X-rays and diagnostic tests for a $50 copay and no coinsurance. Diagnostic radiological services require a copay starting at $175 with no coinsurance, while therapeutic radiological services require a 20% coinsurance, with prior authorization required for diagnostic services.
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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Mount Carmel MediGold No Premium (HMO) plan; however, some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Mount Carmel MediGold No Premium (HMO) with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Prior three-day hospital stays are not required for admission, though additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Mount Carmel MediGold No Premium (HMO) covers acupuncture with a $20 copay and no coinsurance, limited to 6 treatments per year. Over-the-counter (OTC) items are partially covered up to $125 every three months, and meal benefits for chronic illnesses are covered, both featuring no copay and no coinsurance.
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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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