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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 Southwest 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. Members enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and standard mail order. For Tier 2 generic drugs, there is no copay through standard mail order, while standard retail pharmacy copays range from $10 for a one-month supply to $30 for a three-month supply. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 40% coinsurance for both standard pharmacy and mail-order fills. Specialty drugs in Tier 5 carry a 31% coinsurance for a one-month supply at standard pharmacies or mail order.
Additional Benefits
The Mount Carmel MediGold Plus (HMO) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, home health services, and key preventive care. Specialist visits require a $35 copay, while inpatient hospital stays have a $325 daily copay for the first five days and no copay for subsequent days. Emergency care is covered with a $130 copay, and urgent care costs $40, both with no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental care up to a $1,000 limit and eyewear up to a $225 annual limit with no copay. Routine hearing exams are provided with no copay, and prescription hearing aids are covered with copays ranging from $599 to $899. Additionally, members benefit from a $100 quarterly allowance for over-the-counter items with no copay, while durable medical equipment and dialysis services require a standard 20% coinsurance.
Inpatient Hospital See details
Mount Carmel MediGold Plus (HMO) covers inpatient hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Mount Carmel MediGold Plus (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital copays ranging from no copay up to $295 and observation services at a $315 copay per stay. Ambulatory surgical center services require a $295 copay, outpatient substance abuse sessions have a $30 copay, and outpatient blood services have no copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Mount Carmel MediGold Plus (HMO) 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, both with no coinsurance. Transportation services are partially covered, offering unlimited round-trips to plan-approved health-related locations with no copay or 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 and no coinsurance, which is waived if you are admitted to the hospital within 48 hours, and urgent care with a $40 copay and no coinsurance. Worldwide emergency and urgent services are also covered with a $130 copay and no coinsurance, while worldwide emergency transportation has a copay of $200 to $250 with no coinsurance.
Primary Care See details
Mount Carmel MediGold Plus (HMO) covers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits cost a $35 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $30 to $40 and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Mount Carmel MediGold Plus (HMO) covers key preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, with services such as health education, in-home safety assessments, personal emergency response systems, and nutritional counseling not covered by the plan.
Hearing Services See details
Hearing services are covered by Mount Carmel MediGold Plus (HMO), featuring a $35 copay for Medicare-covered exams, no copay for routine exams and fitting evaluations, and no coinsurance for all hearing exam services. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Mount Carmel MediGold Plus (HMO) provides partially covered vision services with no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for eyewear up to a $225 annual limit. While routine eye exams, eyeglasses, and contact lenses are covered, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Mount Carmel MediGold Plus (HMO) partially covers dental services, offering preventive care with no copay or coinsurance up to a $1,000 annual limit, and Medicare-covered dental for a $35 copay and no coinsurance. Comprehensive services like endodontics and periodontics have no copay and 0% to 70% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Mount Carmel MediGold Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 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 20% coinsurance. Diabetic supplies are available with no copay, while diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Mount Carmel MediGold Plus (HMO), featuring no copay and no coinsurance for lab services, and a $20 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services require a minimum $125 copay, outpatient X-rays require a $20 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Mount Carmel MediGold Plus (HMO) with no copay and no coinsurance. This benefit allows eligible members to receive necessary medical care at home with zero out-of-pocket costs.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Mount Carmel MediGold Plus (HMO) with no coinsurance, requiring a $30 copay for both cardiac and intensive cardiac rehabilitation. Pulmonary rehabilitation and supervised exercise therapy (SET) for peripheral artery disease (PAD) are also covered with no coinsurance and a $15 copay.
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold Plus (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 61 through 100, a $218 copay for days 21 through 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Mount Carmel MediGold Plus (HMO) partially covers other services, offering acupuncture for a $20.00 copay and no coinsurance (limited to 6 treatments per year with prior authorization), as well as meal benefits and up to $100.00 in quarterly over-the-counter items with no copay and no coinsurance. Other miscellaneous services and dual-eligible SNP services are not covered under this plan.
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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