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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 2026, 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 2026.
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 $160.00. 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 $250.00 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 $7900.00 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 Cash Back (HMO) plan features a $250 drug deductible and offers affordable options for generic prescriptions. You will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. Tier 2 generic drugs cost a $5 copay for a one-month supply at standard pharmacies, but they feature no copay when ordered through standard mail order. For brand-name and specialty prescriptions, costs are determined by coinsurance percentages. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 40% coinsurance for both standard pharmacies and mail order. Tier 5 specialty drugs are available with a 30% coinsurance for a one-month supply.
Additional Benefits
The Mount Carmel MediGold Cash Back (HMO) plan offers affordable medical coverage with no copay or coinsurance for primary care doctor visits and routine preventive services. For specialized care, members pay copays ranging from $35 to $40 for specialist visits and a $115 copay for emergency room visits. Inpatient hospital stays require a $475 daily copay for the first five days, after which there is no copay. This plan also includes essential supplemental benefits, featuring no copay for routine vision exams, eyewear up to $125 annually, and preventive dental care. Comprehensive dental services are covered with 50% coinsurance up to a $1,000 annual limit, and routine hearing exams feature no copay. Additionally, members receive a $25 quarterly over-the-counter allowance and home health services with no copay.
Inpatient Hospital See details
Mount Carmel MediGold Cash Back (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $475 daily copay for days 1 to 5, no copay for days 6 and beyond, and no coverage for upgrades or non-Medicare-covered stays. Psychiatric stays require a $415 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Mount Carmel MediGold Cash Back (HMO) covers outpatient services with no coinsurance, featuring copays of $10 to $495 for outpatient hospital services, $405 per stay for observation services, and $495 for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Mount Carmel MediGold Cash Back (HMO) plan with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Mount Carmel MediGold Cash Back (HMO) covers ground ambulance services with a $300 copay and air ambulance services with a $350 copay, with no coinsurance required for either. Non-emergency transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Mount Carmel MediGold Cash Back (HMO) with a $115 copay (waived if admitted to the hospital within 48 hours) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $115 copay and no coinsurance, and worldwide emergency transportation has a copay of $300 to $350 with no coinsurance.
Primary Care See details
Mount Carmel MediGold Cash Back (HMO) offers partially covered primary care benefits with no copay and no coinsurance for primary care doctor visits, and copays ranging from $35 to $40 with no coinsurance for specialist, therapy, and mental health services. Telehealth options are also available with a $0 to $40 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Mount Carmel MediGold Cash Back (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered, excluding services such as health education, weight management, personal emergency response systems, and in-home safety assessments.
Hearing Services See details
Mount Carmel MediGold Cash Back (HMO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $599 to $899 copay for up to two aids yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Mount Carmel MediGold Cash Back (HMO), offering one routine eye exam per year and eyewear up to a $125 annual limit with no copay, no coinsurance, and no deductible. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Mount Carmel MediGold Cash Back (HMO) partially covers dental services up to a $1,000 annual limit, offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental with a $40 copay and no coinsurance. Comprehensive benefits like restorative care and oral surgery require no copay and 50% coinsurance, while endodontics, periodontics, prosthodontics, implants, orthodontics, and other preventive services are not covered.
Home Infusion bundled Services See details
Mount Carmel MediGold Cash Back (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Mount Carmel MediGold Cash Back (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Mount Carmel MediGold Cash Back (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and diabetic therapeutic shoes or inserts require a 20% coinsurance, with prior authorization required for these benefits and manufacturer limitations applying to diabetic supplies.
Diagnostic and Radiological Services See details
Mount Carmel MediGold Cash Back (HMO) covers diagnostic and radiological services, offering lab services for a $10 copay and diagnostic procedures for a $50 copay with no coinsurance. Radiological services are covered with a $50 copay for X-rays, a minimum $350 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Mount Carmel MediGold Cash Back (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Mount Carmel MediGold Cash Back (HMO) with no coinsurance, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Mount Carmel MediGold Cash Back (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 through 20 and days 61 through 100, while a $218 daily copay applies for days 21 through 60, with no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Other services covered by Mount Carmel MediGold Cash Back (HMO) include acupuncture for a $20 copay and no coinsurance, which is limited to 6 treatments per year and requires prior authorization. Additionally, the plan offers meal benefits for chronic illnesses and a $25 quarterly over-the-counter (OTC) allowance, both with no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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