2018 MediGold Plan Options in Your Area

MediGold Plans Remove Option MediGold Southwest OH Essential Care (HMO) Remove Option MediGold Southwest OH Classic Preferred (HMO) Remove Option MediGold Medical Only (HMO)
Plan Premiums $0 monthly premium $120 monthly premium $60 monthly premium
PlansBest Match? Enroll View Details Enroll View Details Enroll View Details
Medical Deductible $0 $0 $0
Out-of-Pocket Maximum $4,500 $3,900 $3,900
Medical Benefits You pay: You pay: You pay:
Family Doctor Visits $10 $5 $5
Specialty Doctor Visits $50 $45 $30
Preventive dental exam, cleaning and bitewing X-rays twice a year $0 $0 $0
Durable Medical Equipment 20% 20% 20%
Lab Test and Pathology $10 $0 $0
Basic X-ray $50 $20 $30
Diagnostic Test $50 $20 $30
Urgent Care Visit $40 $40 $40
Emergency Room Visit $80 $80 $80
Outpatient Surgery $275 $125 $125
Inpatient Hospital Visit $285 per day 1-7,
$0 after day 7
$190 per stay $75 per day 1-7
$0 after day 7
Part D Drug Benefits — Extra savings available at mail. Ask for details. Included!
30-day supply
30-day supply
This plan does not include Part D drug benefits.
Part D Deductible $250 applies to tiers 3-5 only $0 Not applicable
Tier 1 Drugs:
Preferred Generic Drugs
$2 $0
Tier 2 Drugs:
Generic Drugs
$18 $15
Tier 3 Drugs:
Preferred Brand Drugs
$45 $45
Tier 4 Drugs:
Non-Preferred Drugs
$95 $75
Tier 5 Drugs:
Specialty Tier Drugs
28% 33%

MediGold's 2018 Dental Plan may be separately purchased by new and existing MediGold members.

Learn more about MediGold's Dental Plan

MediGold is available to residents living in: Adams, Brown, Butler, Champaign, Clark, Clermont, Clinton, Delaware, Fairfield, Fayette, Franklin, Greene, Hamilton, Highland, Knox, Licking, Madison, Miami, Monroe, Montgomery, Morgan, Noble, Perry, Pickaway, Pike, Preble, Ross, Union, Warren and Washington counties, Ohio. Plans and premiums may vary by county. This chart is not a complete list of benefits. For more detailed information about our plan options, view the Summary of Benefits.

Out-of-network/non-contracted providers are under no obligation to treat MediGold members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

You may receive prescription drugs at home using our network mail order program, generally within 10 calendar days of when your order is received. For questions about mail order medication, call 1-866-785-5714 option 4 (TTY 711). Our mail order pharmacy is to obtain consent prior to shipping or delivering any prescriptions that the beneficiary did not personally initiate, unless the perscriber has initiated other mail order prescriptions for the beneficiary in the last 12 months.

Updated 10/2018