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 Annual Notice of Changes, Evidence of Coverage and Summary of Benefits documents. They provide information about this plan option in more detail.
|
2013 |
MediGold Classic Preferred (HMO) |
|
Monthly MediGold Premium |
$99 |
|
Annual Deductible |
$0 |
|
Annual Out-of-Pocket Maximum Protection |
New! $3,200 |
|
Medical Benefits |
Your copay: |
|
Doctor Office Visits (Primary Care) |
New! $0 |
|
Doctor Office Visits(Specialty Care) |
$25 |
|
Lab Tests, Home Health Care, and Medicare-covered Preventive Services |
$0 |
|
Hospital Admission |
$0 per stay |
|
Outpatient Diagnostic Test or X-Ray |
$15 |
|
Outpatient Surgery |
$125 |
|
Diabetic Supplies |
0% |
|
Emergency Room Visit |
$65 |
|
Prescription Drug Benefits (Part D) You pay no deductibles! |
Your copay for a |
|
Tier 1 - Preferred Generic Drugs |
$0 Tier 1 drugs covered through the gap. |
|
Tier 2 - Non-Preferred Generic Drugs |
$10 Tier 2 drugs covered through the gap. |
|
Tier 3 - Preferred Brand Drugs |
$38 |
|
Tier 4 - Non-Preferred Brand Drugs |
$50 |
|
Tier 5 - Specialty Tier Drugs |
33% |
2013 MediGold Classic Preferred (HMO) Plan Documents
2013 MediGold Central Ohio Summary of Benefits - HMO Plans
2013 MediGold Classic Preferred (HMO) Evidence of Coverage
2013 MediGold Classic Preferred (HMO) Annual Notice of Changes
2012 MediGold Classic Preferred (HMO) Plan Documents
2012 MediGold Classic Preferred (HMO) Summary of Benefits
2012 MediGold Classic Preferred (HMO) Evidence of Coverage
2012 MediGold Classic Preferred (HMO) Annual Notice of Changes
Last Updated 5/9/2013 3:52:32 PM