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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 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 Northwest 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 $13.00. 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 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:
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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 a copay or coinsurance based on the drug tier and pharmacy used. For example, you will pay a $10 copay at a standard pharmacy for tier 1 drugs, and 25% coinsurance for tier 2 drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Mount Carmel MediGold No Premium (HMO) plan offers a wide range of benefits with varying cost-sharing options. Inpatient hospital stays have a copay, while outpatient services, including primary care and preventive services, often have no copay. The plan also includes coverage for hearing, vision, and dental services, along with additional benefits like home health and ambulance services. This plan provides coverage for services such as emergency care, mental health, and substance abuse treatment, with copays applying to many of these services. Diagnostic and radiological services have copays, and durable medical equipment and prosthetics have a coinsurance. The plan also provides coverage for home infusion and dialysis services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $295 copay for days 1-4 and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $250, and observation services with no copay. Ambulatory Surgical Center (ASC) Services have a $250 copay, while outpatient substance abuse services have a $35 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Mount Carmel MediGold No Premium (HMO) plan, with a copay of $50.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mount Carmel MediGold No Premium (HMO) plan. Ground ambulance services have a $200 copay, and air ambulance services have a $250 copay, but there is no coinsurance for either. Transportation services to a plan-approved health-related location have no copay, and there is no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Mount Carmel MediGold No Premium (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a copay between $200 and $250; there is no coinsurance for any of these services.
Primary Care See details
The Mount Carmel MediGold No Premium (HMO) plan offers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, including fitness benefits and remote access technologies, are covered with no 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) are covered with a copay between $599 and $899, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $35, and eyewear with a combined maximum benefit of $200 per year, with no copay for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $35 copay for Medicare Dental Services and no copay for Other Dental Services. 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 Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation 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 with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay of $10 for Diagnostic Procedures/Tests, and a copay of at most $145 for Diagnostic Radiological Services. Lab Services have no copay, and Outpatient X-Ray Services have a $10 copay. 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 any of the sub-services. There is a copay for some services, but the exact amount is not specified.
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, but there is 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, and Over-the-Counter (OTC) items with no copay up to $110 every three months. The plan also covers a meal benefit with no copay for a chronic illness. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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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