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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 Northwest 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 $14.00. 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)
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Drug Coverage
The Mount Carmel MediGold No Premium (HMO) plan features a $150 drug deductible and offers excellent savings on generic medications. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a one-month supply at standard pharmacies, or no copay at all when using standard mail order. For higher-tier medications, the plan transitions to 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 are covered with a 31% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Mount Carmel MediGold No Premium (HMO) plan offers comprehensive coverage featuring no copays for primary care visits, routine annual hearing and vision exams, home health services, and standard preventive care. For specialist visits, physical therapy, and mental health services, members pay a $35 copay with no coinsurance. Inpatient hospital stays require a $295 daily copay for the first four days, after which there is no copay for days five through 90. Emergency room visits carry a $110 copay, while ground ambulance services require a $200 copay, both with no coinsurance. Additional benefits include preventive dental care with no copay up to $1,000 annually, a $200 yearly allowance for eyewear, and a quarterly $100 over-the-counter item allowance with no copay. Diagnostic lab services and unlimited medical transportation to approved locations are also available with no copay.
Inpatient Hospital See details
Mount Carmel MediGold No Premium (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $295 daily copay for days 1 through 4, followed by no copay for days 5 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Mount Carmel MediGold No Premium (HMO) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $250, alongside observation services for a $285 copay per stay. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse sessions have a $35 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Mount Carmel MediGold No Premium (HMO) covers partial hospitalization with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Mount Carmel MediGold No Premium (HMO) plan, with ground ambulance services requiring a $200 copay and air ambulance requiring a $250 copay, both with no coinsurance. Transportation services are partially covered, offering unlimited round trips to plan-approved health locations with no copay and no coinsurance, though stretcher rides and transportation to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Mount Carmel MediGold No Premium (HMO) with a $110 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $110 to $250 and no coinsurance.
Primary Care See details
Mount Carmel MediGold No Premium (HMO) provides primary care physician services with no copay and telehealth with a $0 to $35 copay, both featuring no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance, while podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services under the Mount Carmel MediGold No Premium (HMO) are covered with no copay and no coinsurance, including annual physicals, kidney education, fitness benefits, and glaucoma screenings. However, additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Mount Carmel MediGold No Premium (HMO) covers hearing services with no coinsurance, requiring a $35 copay for Medicare-covered exams and no copay for routine annual exams or fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two devices per year, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Mount Carmel MediGold No Premium (HMO) partially covers vision services with no coinsurance or deductibles, offering no copay for one annual routine eye exam and eligible eyewear up to a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Mount Carmel MediGold No Premium (HMO), with Medicare-covered dental requiring a $35 copay and no coinsurance, and preventive services available with no copay or coinsurance up to $1,000 annually. Comprehensive care such as restorative and endodontic services has no copay and 50% to 70% coinsurance, though implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Mount Carmel MediGold No Premium (HMO) with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and general drugs carry a coinsurance of 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 durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Mount Carmel MediGold No Premium (HMO) covers diagnostic services with no coinsurance, featuring a $0 copay for lab services and a $10 copay for diagnostic procedures. Covered radiological services include outpatient X-rays for a $10 copay, diagnostic radiology for a $145 copay, and therapeutic radiology for 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Mount Carmel MediGold No Premium (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Mount Carmel MediGold No Premium (HMO) feature no coinsurance, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, with copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold No Premium (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and 61 to 100, and a $218 daily copay for days 21 to 60. Prior three-day hospital stays are not required for admission, but additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Mount Carmel MediGold No Premium (HMO) partially covers other services, offering acupuncture for a $20 copay and no coinsurance up to 6 treatments per year with prior authorization, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $100 every three months, while certain other miscellaneous 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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