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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 2026, 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 2026.
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 $34.00. 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 a $100.00 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 $4400.00 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 Plus (HMO) prescription drug plan features an annual drug deductible of $100. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies or through standard mail order. Tier 2 generic drugs also have no copay when filled through standard mail order, though filling at a standard pharmacy costs a $10 copay for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance for both standard pharmacy and standard mail order fills. Tier 5 specialty drugs require a 31% coinsurance for a one-month supply at standard pharmacies and through standard mail order.
Additional Benefits
The Mount Carmel MediGold Plus (HMO) plan offers comprehensive medical coverage with no coinsurance for many primary services. Members benefit from no copay for primary care physician visits, preventive care, and home health services, while specialist visits carry a $35 copay. For acute care, inpatient hospital stays require a $325 daily copay for days 1 through 5, after which there is no copay. Routine dental and vision services are covered with no copay, though dental has a $1,000 annual limit and vision has a $225 limit. Prescription hearing aids feature copays between $599 and $899, while durable medical equipment and dialysis require a 20% coinsurance with no copay. Skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 60.
Inpatient Hospital See details
Mount Carmel MediGold Plus (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Mount Carmel MediGold Plus (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $295 for outpatient hospital services and $315 per stay for observation services. Ambulatory surgical center services require a $295 copay, outpatient substance abuse sessions have a $30 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Mount Carmel MediGold Plus (HMO) covers partial hospitalization services with a $45.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Mount Carmel MediGold Plus (HMO) covers ground ambulance services with a $200 copay and air ambulance services with a $250 copay, with no coinsurance required for either. Transportation services are partially covered, offering unlimited round trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Mount Carmel MediGold Plus (HMO) covers emergency services with a $130 copay, which is waived if admitted within 48 hours, and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency and urgent coverage are available with a $130 copay, while worldwide emergency transportation has a copay of $200 to $250, all featuring no coinsurance.
Primary Care See details
Mount Carmel MediGold Plus (HMO) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $40 copay, mental health and psychiatric services have a $30 copay, and telehealth options range from no copay to $35, all with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Mount Carmel MediGold Plus (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, fitness benefits, and remote access technologies with no copays and no coinsurance. This benefit is only partially covered, as several supplemental services such as health education, personal emergency response systems (PERS), and nutritional or dietary benefits are not covered.
Hearing Services See details
Hearing services covered by Mount Carmel MediGold Plus (HMO) require no deductible, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $599 to $899 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Mount Carmel MediGold Plus (HMO) offers partially covered vision services, featuring no copay, no coinsurance, and no deductible for covered care. While one routine eye exam per year and eyewear are covered up to a $225 annual limit, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Mount Carmel MediGold Plus (HMO) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, while preventive services have no copay or coinsurance up to a $1,000 yearly limit. Covered comprehensive services, such as restorative care and endodontics, feature no copay and coinsurance ranging from 50% to 70%.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Mount Carmel MediGold Plus (HMO) with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Mount Carmel MediGold Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold Plus (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 require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Mount Carmel MediGold Plus (HMO) covers diagnostic and radiological services, requiring prior authorization and no coinsurance for diagnostic services, which feature no copay for lab tests and a $20 copay for procedures. Radiological services are covered with a $20 copay for X-rays, a $125 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Mount Carmel MediGold Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Mount Carmel MediGold Plus (HMO) with no coinsurance. Members pay a $30 copay for cardiac and intensive cardiac rehabilitation services, and a $15 copay for pulmonary rehabilitation and supervised exercise therapy (SET) for peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and days 61 through 100, but a $218 daily copay applies for days 21 through 60.
Other Services See details
Mount Carmel MediGold Plus (HMO) offers partially covered other services, including acupuncture for a $20 copay and no coinsurance, as well as meal benefits and over-the-counter items with no copay and no coinsurance. Other services, such as Dual Eligible SNPs and additional unspecified services, are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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