Compare Our Plans

MediGold offers several 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 on any of the plans listed below, click on the plan name at the top of the chart.

2012

MediGold Essential Care (HMO)

MediGold Classic Preferred (HMO)

MediGold Medical Only (HMO)

MediGold Network Choice (PPO)

MediGold Value Choice (PPO)*

Monthly MediGold Premium

$0

$97

$43

$149

$28

Annual Deductible

$0

$0

$0

$0

$0

Annual Out-of-Pocket Maximum Protection
The most you could spend on medical care in 2012

 $3,400 $3,400 $3,400

$3,400 in-network
$5,100 combined in-network & out-of-network

$3,400 in-network
$5,100 combined in-network & out-of-network

Medical Benefits

Your copay:

Your copay:

Your copay:

Your copay:

Your copay:

Doctor Office Visits  (Primary Care)

$10

$10

$10

$15 in-network
$20 out-of-network

$20 in-network
& out-of-network

Doctor Office Visits(Specialty Care)

$45

$25

$25

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

$45 in-network
& out-of-network

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

$0

$0

$0

$0 in-network
$0-60 out-of-network

$0 in-network
& out-of-network

Hospital Admission

$225 per day for days 1-7
$0 for additional days

$0

$50 per day for days 1-7
$0 for additional days

 

$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

$225 per day for days 1-7; $0 for additional days in-network & out-of-network

 

Outpatient Diagnostic Test or X-Ray

$55

$15

$35

$45 in-network
$60 out-of-network

$45 in-network
& out-of-network

Outpatient Surgery

$250

$125

$125

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

$250 in-network
& 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 and have some benefits or discounts through the Coverage Gap.

Your copay for a
30-day supply:

Your copay for a
30-day supply:

Part D not included

Your copay for a
30-day supply:

Your copay for a
30-day supply:

Tier 1 - Preferred Generic Drugs

$4 retail

$0 mail

$4 retail

$0 mail

 

$4 retail

$0 mail

$4 retail

$0 mail

Tier 2 - Non-Preferred Generic Drugs

$12 retail/mail

$10 retail/mail

 

$12 retail/mail

$12 retail/mail

Tier 3 - Preferred Brand Drugs

$45 retail/mail

$38 retail/mail

 

$45 retail/mail

$45 retail/mail

Tier 4 - Non-Preferred Brand Drugs

$75 retail/mail

$50 retail/mail

 

$75 retail/mail

$75 retail/mail

Tier 5 - Specialty Tier Drugs

33% retail/mail

33% retail/mail

 

33% retail/mail

33% retail/mail

Dental Benefits

MediGold's 2012 Dental Plan may be separately purchased by new and existing MediGold members. The plan is administered by Delta Dental for a monthly premium of $20. Learn more about MediGold's Dental Plan.

* MediGold Value Choice (PPO) is only available in Clark, Greene, Knox, Montgomery and Richland counties, Ohio. View a map of our Service Area.

Last Updated 11/15/2011 10:47:18 AM