A non-government entity
Mount Carmel MediGold Cash Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mount Carmel MediGold Cash Back (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 Cash Back (HMO) in 2025, please refer to our full plan details page.
Mount Carmel MediGold Cash Back (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Central, Southwest, and Northwest 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 Cash Back (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 Cash Back (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 Cash Back (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 $161.90. 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 $350.00 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 $6400.00 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 Cash Back (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 Cash Back (HMO) plan has a $350 deductible for prescription drugs. After the deductible, your cost will vary depending on the drug tier and the pharmacy you use. For Tier 1 preferred generic drugs through standard mail, there is no copay. Standard generic drugs have a 25% coinsurance. Preferred brand drugs have a 50% coinsurance, and non-preferred drugs have a 28% coinsurance.
Additional Benefits
The Mount Carmel MediGold Cash Back (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $450 copay for the first five days, outpatient services with varying copays, and no copay for preventive services like annual physical exams. The plan also provides coverage for hearing, vision, and dental services, with specific copays for exams and hearing aids, and no copays for many other services. Additional benefits include ambulance services with copays, emergency services with copays, and home health services with no copay. The plan also covers services like acupuncture, over-the-counter items, and a meal benefit for chronic illnesses. However, it's important to note that some services, such as cardiac rehabilitation and certain dental, vision, and hearing services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $450 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $10-$475, observation services with no copay, ambulatory surgical center services with a $475 copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Mount Carmel MediGold Cash Back (HMO) plan. Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a $350 copay, and there is no coinsurance for either. 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 by the Mount Carmel MediGold Cash Back (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Transportation has a copay between $300 and $350; all of these services have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for 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 $40 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, Other Health Care Professional with a copay between $0 and $40, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with a copay between $0 and $40, and Opioid Treatment Program Services with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
The Mount Carmel MediGold Cash Back (HMO) plan covers preventive services with no copay for an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Additional preventive services, including fitness benefits and remote access technologies have a copay, but the exact amount is not specified in the provided information. However, health education, in-home safety assessment, personal emergency response systems, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $40 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $599 and $899, but hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with no copay; however, upgrades are not covered. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay.
Dental Services See details
The Mount Carmel MediGold Cash Back (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment with no copay. The plan also covers restorative services and oral and maxillofacial surgery with a 50% coinsurance, as well as adjunctive general services with no copay. Endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Mount Carmel MediGold Cash Back (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the Mount Carmel MediGold Cash Back (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have no copay, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a $50 copay for diagnostic procedures/tests, and lab services with a $10 copay. Outpatient X-ray services have a $50 copay, while diagnostic radiological services have a copay of at most $295, 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 Cash Back (HMO) plan with no copay and no coinsurance. However, 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 Cash Back (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Mount Carmel MediGold Cash Back (HMO) plan with no copay for days 1-20 and days 56-100, and a $214 copay for days 21-55. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Mount Carmel MediGold Cash Back (HMO) plan covers acupuncture with a $20 copay and a limit of 6 treatments per year, and over-the-counter items with no copay, up to a $50 maximum benefit every three months. The plan also provides a meal benefit with no copay for chronic illnesses, but does not cover Dual Eligible SNPs with Highly Integrated Services. Several other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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