A non-government entity
Mount Carmel MediGold Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold Plus (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 Plus (HMO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Plus (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Central 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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $4200.00 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 Plus (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 Plus (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs purchased through standard mail, there is no copay. For standard generic drugs, the coinsurance is 25% for both standard and mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Mount Carmel MediGold Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $325 copay for the first five days, with no copay thereafter. Outpatient services, primary care visits, preventive services, and home health services often have no copay, while other services like specialist visits, hearing exams, and dental care have copays ranging from $20 to $225. This plan includes coverage for ambulance and transportation services, emergency services, and offers additional benefits such as vision, hearing, and dental care. It also provides coverage for medical equipment and diagnostic services, with some services like skilled nursing facilities, and certain specialist services, and outpatient services having copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $225, observation services with no copay, and ambulatory surgical center services with a $225 copay. Outpatient substance abuse services are covered with a $30 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $45 copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Mount Carmel MediGold Plus (HMO). Ground ambulance services have a $200 copay, while air ambulance services have a $250 copay; there is no coinsurance for either service. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance, with the mode of transportation including taxi, rideshare services, bus/subway, and medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Mount Carmel MediGold Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a copay between $200 and $250; all services have no coinsurance.
Primary Care See details
The Mount Carmel MediGold Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (routine care not covered), occupational therapy services with a $40 copay, physician specialist services with a $35 copay, mental health specialty services (individual and group sessions with a $30 copay), physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$35 copay, and opioid treatment program services with a $30 copay. Podiatry services are not covered.
Preventive Services See details
The Mount Carmel MediGold Plus (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Medicare-covered glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay for 1 visit per year, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for 2 visits per year, but prescription hearing aids for the inner ear, outer ear, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, and routine eye exams have no copay. Eyewear has no copay, and includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum of $225 per year. Upgrades are not covered.
Dental Services See details
Dental Services include 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Mount Carmel MediGold Plus (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by Mount Carmel MediGold Plus (HMO), including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
The Mount Carmel MediGold Plus (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a $20 copay, and lab services with no copay. Diagnostic radiological services have a copay of at least $125, while therapeutic radiological services have at least 20% coinsurance, and outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Mount Carmel MediGold Plus (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 not covered by the Mount Carmel MediGold Plus (HMO) plan. Although the plan mentions copays, it also specifies that Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Mount Carmel MediGold Plus (HMO) plan. For days 1-20 and 56-100, there is no copay, while days 21-55 have a $214 copay.
Other Services See details
The Mount Carmel MediGold Plus (HMO) plan covers acupuncture with a $20 copay, and up to 6 treatments per year, and also covers over-the-counter items with no copay and a maximum benefit of $120 every three months. This plan also covers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others 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