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Compare Our Plans

MediGold offers several HMO and PPO plan options to fit your needs. To help you determine which plan is best for you, use the chart below to compare the benefits available with each of our plans. If you would like more detailed information (Summary of Benefits) on any of the plans listed below, click on the plan name at the top of the chart.

2014

MediGold Essential Care (HMO)

MediGold Classic Preferred (HMO)

MediGold Medical Only (HMO)

MediGold Network Choice (PPO)

MediGold Value Choice (PPO)

Monthly MediGold Premium

$0

$99

$45

$143

$38

Annual Deductible

$0

$0

$0

$0

$0

Annual Out-of-Pocket Maximum Protection
The most you could spend on medical care in 2014

$3,200 $3,200 $3,200

$3,200 in-network
$5,000 combined in-network & out-of-network

$3,200 in-network
$5,000 combined in-network & out-of-network

Medical Benefits

Your copay:

Your copay:

Your copay:

Your copay:

Your copay:

Doctor Office Visits  (Primary Care)

$10

$0

$0

$0 in-network
$20 out-of-network

$0 in-network
$20 out-of-network

Doctor Office Visits(Specialty Care)

$45

$30

$30

$30 in-network
$40 out-of-network

$40 in-network
$45 out-of-network

Lab Tests, Home Health Care, and Medicare-covered Preventive Services

$0-$15

$0

$0

$0 in-network & out-of-network

$0-$15 in-network & out-of-network

Hospital Admission

$275 per day for days 1-6
$0 for additional days

Ask about our inpatient out-of-pocket maximum protection.

$0 per stay

$75 per day for days 1-7
$0 for additional days

Ask about our inpatient out-of-pocket maximum protection.

$200 per day for days 1-7; $0 for additional days in-network

$250 per day for days 1-7; $0 for additional days out-of-network

Ask about our inpatient out-of-pocket maximum protection.

$275 per day for days 1-7; $0 for additional days in-network

$295 per day for days 1-7; $0 for additional days out-of-network

Ask about our inpatient out-of-pocket maximum protection.

Outpatient Diagnostic Test or X-Ray

$60

$15

$40

$40 in-network
$60 out-of-network

$50 in-network
$65 out-of-network

Outpatient Surgery

$250

$125

$125

$225 in-network
$300 out-of-network

$250 in-network
$300 out-of-network

Diabetic Supplies

0%

0%

0%

0% in-network
& out-of-network

0% in-network
& out-of-network

Emergency Room Visit

$65

$65

$65

$65 in-network
& out-of-network

$65 in-network
& out-of-network

Prescription Drug Benefits (Part D)

You pay no deductibles!

Your copay:

Your copay:

Part D not included

Your copay:

Your copay:

Tier 1 - Preferred Generic Drugs

30-day supply:

$2 retail/mail

90-day supply:

$6 retail/$0 mail

Tier 1 drugs covered through the gap.

30-day supply:

$0 retail/mail

90-day supply:

$0 retail/$0 mail

Tier 1 drugs covered through the gap.

 

30-day supply:

$0 retail/mail

90-day supply:

$0 retail/mail

Tier 1 drugs covered through the gap.

30-day supply:

$0 retail/mail

90-day supply:

$0 retail/mail

Generic drug discounts available through the gap.

Tier 2 - Non-Preferred Generic Drugs

30-day supply:

$12 retail/mail

90-day supply:

$36 retail/$24 mail

30-day supply:

$10 retail/mail

90-day supply:

$30 retail/$20 mail

Tier 2 drugs covered through the gap.

 

30-day supply:

$12 retail/mail

90-day supply:

$36 retail/$24 mail

Tier 2 drugs covered through the gap.

30-day supply:

$12 retail/mail

90-day supply:

$36 retail/$24 mail

Tier 3 - Preferred Brand Drugs

30-day supply:

$45 retail/mail

90-day supply:

$135 retail/$90 mail

30-day supply:

$38 retail/mail

90-day supply:

$114 retail/$76 mail

 

30-day supply:

$45 retail/mail

90-day supply:

$135 retail/$90 mail

30-day supply:

$45 retail/mail

90-day supply:

$135 retail/$90 mail

Tier 4 - Non-Preferred Brand Drugs

30-day supply:

$85 retail/mail

90-day supply:

$255 retail/$170 mail

30-day supply:

$50 retail/mail

90-day supply:

$150 retail/$100 mail

 

30-day supply:

$85 retail/mail

90-day supply:

$255 retail/$170 mail

30-day supply:

$85 retail/mail

90-day supply:

$255 retail/$170 mail

Tier 5 - Specialty Tier Drugs

33%

33%

 

33%

33%

Dental Benefits

MediGold's 2014 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.

Last Updated 3/18/2014 9:56:16 AM