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MediGold Classic Preferred (HMO)

MediGold Classic Preferred (HMO) is a Medicare Advantage Health Maintenance Organization (HMO), which includes Part D prescription drug coverage. The chart below provides a summary of the benefits available with this plan. You may also find it helpful to review the Evidence of Coverage and Summary of Benefits documents. They provide information about this plan option in more detail.

2015

MediGold Classic Preferred (HMO)

Your Monthly Plan Premium

$99

You will pay No Deductibles

$0

You'll enjoy our Annual Out-of-Pocket Maximum for Added Protection

$3,200

Medical Benefits Included!

Your copay:

Preventive Care

$0

Fitness Center Membership

$0

Flu Shots

$0

Diabetes Supplies

$0

Office Visit (Primary Care Provider)

$0

Office Visit (Specialty Care Provider)

$30

Outpatient Lab Test

$0

Outpatient Diagnostic Test or X-ray

$20

Outpatient Surgery

$125

Urgent Care Visit

$35

Emergency Room Visit

$65 Worldwide

Inpatient Hospital Care (per stay)

Ask how we further limit your inpatient costs per year.

$0 per stay

Home Health Care

$0

Prescription Drug (Part D) Benefits Included!

Note: 30, 60 or 90-day supply of drugs may be obtained from participating retail or mail order pharmacies. Extra Savings at mail. Ask about it!

Your copay for a 30-day supply: 

 

Tier 1 - Preferred Generic Drugs

$0

Tier 2 - Non-Preferred Generic Drugs

$15

Tier 3 - Preferred Brand Drugs

$38

Tier 4 - Non-Preferred Brand Drugs

$50

Tier 5 - Specialty Drugs

33%

Coverage Gap discounts or benefits?

YES

Dental Benefits

MediGold's 2015 Dental Plan may be separately purchased by new and existing MediGold members. The plan is administered by Delta Dental for a monthly premium of $23. Learn more about MediGold's Dental Plan.

2015 MediGold Classic Preferred (HMO) Plan Documents

2015 MediGold Central Ohio Summary of Benefits - HMO Plans

2015 MediGold Classic Preferred (HMO) Evidence of Coverage

Last Updated 9/29/2014 11:32:53 PM