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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 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 Southwest 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 $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 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:
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Drug Coverage
The Mount Carmel MediGold Plus (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs based on the drug tier and pharmacy type. For example, you may pay a $10 copay for a standard generic drug, or 25% coinsurance for a standard generic drug. 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 also offers a reduced premium for those who qualify for the low-income subsidy.
Additional Benefits
The Mount Carmel MediGold Plus (HMO) plan offers a variety of health benefits. This plan includes coverage for inpatient hospital stays, outpatient services, primary care, preventive services, and more, with varying copays depending on the service. You'll also find coverage for emergency services, hearing, vision, and dental services, as well as home health and skilled nursing facility care.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $225, observation services with no copay, ambulatory surgical center services with a $225 copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Mount Carmel MediGold Plus (HMO) plan. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mount Carmel MediGold Plus (HMO) plan. Ground ambulance services have a $200 copay, while air ambulance services have a $250 copay; there is no coinsurance for either. Transportation services to a plan-approved health-related location are covered with no copay and no coinsurance. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Mount Carmel MediGold Plus (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a copay between $200 and $250; all 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, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, and mental health specialty services with a $30 copay for individual or group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $30 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay. Additional preventive services like Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $599 and $899, and OTC hearing aids are not covered. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Mount Carmel MediGold Plus (HMO) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay, up to a combined maximum of $225 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, while upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $35 copay, and other dental services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, while Endodontics and Periodontics have a 70% coinsurance. Orthodontics and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Mount Carmel MediGold Plus (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Mount Carmel MediGold Plus (HMO) plan covers Diagnostic and Radiological Services, including diagnostic procedures and tests with a $20 copay, lab services with no copay, and outpatient X-ray services with a $20 copay. Diagnostic Radiological Services have a copay of at most $125, and 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 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 covered by the Mount Carmel MediGold Plus (HMO) plan. However, 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 by 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 over-the-counter items with no copay, and a meal benefit with no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other 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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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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