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Mount Carmel MediGold Premium Choice (PPO)

H1846 - 005 - 0
4 out of 5 stars (4 / 5)

Mount Carmel MediGold Premium Choice (PPO) is a Medicare Advantage Plan by MediGold.

This page features plan details for 2025 Mount Carmel MediGold Premium Choice (PPO) H1846 – 005 – 0 available in Central and Southwest Ohio.

Locations

Mount Carmel MediGold Premium Choice (PPO) is offered in the following locations.

Adams County, Ohio
Auglaize County, Ohio
Brown County, Ohio

Click to see more locations

Plan Overview

Mount Carmel MediGold Premium Choice (PPO) offers the following coverage and cost-sharing.

Insurer:MediGold
Health Plan Deductible:$0
MOOP:$8,950 In and Out-of-network
$5,700 In-network
Drugs Covered:Yes

Ready to sign up for Mount Carmel MediGold Premium Choice (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Mount Carmel MediGold Premium Choice (PPO) has a monthly premium of $13.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $13.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Mount Carmel MediGold Premium Choice (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $150.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$13.00$0.00

Initial Coverage Phase

After you pay your $150.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Mount Carmel MediGold Premium Choice (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Endodontics
    • In-Network: 70 Coins – No Co pay
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – No Co pay
  • Periodontics
    • In-Network: 70 Coins – No Co pay
  • Restorative Services
    • In-Network: 50 Coins – No Co pay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Fluoride Treatment
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – – Copay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $225 copay
    • Out-of-Network: 40% coinsurance
  • Diagnostic tests and procedures
    • Out-of-Network: 40% coinsurance (Authorization Required)
    • In-Network: $60 copay (Authorization Required)
  • Lab services
    • In-Network: $10 copay (Authorization Required)
    • Out-of-Network: $20 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $50 copay
    • Out-of-Network: 40% coinsurance

Doctor visits

  • Specialist
    • In-Network: $40 copay per visit
    • Out-of-Network: $60 copay per visit
  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $25 copay per visit

Emergency care/Urgent care

  • Emergency
    • $110 copay per visit (always covered)
  • Urgent care
    • $45 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $40 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: $60 copay

Ground ambulance

    • In-Network: $275 copay
    • Out-of-Network: $275 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Out-of-Network: $60 copay
  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • In-Network: $0 copay
  • Hearing aids
    • In-Network: $599-899 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $40 copay
    • Out-of-Network: $60 copay
  • Hearing aids
    • Out-of-Network: $599-899 copay (Limits Apply)

Inpatient hospital coverage

    • In-Network: $395 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 40% per stay (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $8,950 In and Out-of-network
      $5,700 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 0-30% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 0-30% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • Out-of-Network: $60 copay
  • Inpatient hospital – psychiatric
    • In-Network: $395 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 40% per stay (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $60 copay
  • Outpatient individual therapy visit
    • In-Network: $40 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $40 copay
    • Out-of-Network: $60 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $60 copay
  • Outpatient group therapy visit
    • In-Network: $40 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $40 copay

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $10-325 copay per visit
    • Out-of-Network: 40% coinsurance per visit

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $40 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $60 copay
    • In-Network: $40 copay
  • Occupational therapy visit
    • Out-of-Network: $60 copay

Skilled Nursing Facility

    • Out-of-Network: 50% per stay
    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 55
      $0 per day for days 56 through 100

Transportation

    • Not covered

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: $50 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Dental Silver

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $16.00
    • Max Coverage: $500.00
    • Coverage Periodicity: Every year

Diagnostic and Preventive Dental

  • Other Diagnostic Dental Services, Other Preventive Dental Services
    • Monthly Premium: $16.00
    • Max Coverage: $500.00
    • Coverage Periodicity: Every year

Ready to sign up for Mount Carmel MediGold Premium Choice (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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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.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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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.

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