MediGold Essential Care (HMO)
MediGold Essential Care (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 Essential Care (HMO) |
|
Monthly MediGold Premium |
$0 |
|
Annual Deductible |
$0 |
|
Annual Out-of-Pocket Maximum Protection |
New! $3,200 |
|
Medical Benefits |
Your copay: |
|
Doctor Office Visits (Primary Care) |
New! $5 |
|
Doctor Office Visits(Specialty Care) |
$45 |
|
Lab Tests, Home Health Care, and Medicare-covered Preventive Services |
$0 |
|
Hospital Admission |
$225 per day for days 1-7 New! Ask about our inpatient out-of-pocket maximum protection. |
|
Outpatient Diagnostic Test or X-Ray |
$55 |
|
Outpatient Surgery |
$250 |
|
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 |
New! $0 New! Tier 1 drugs covered through the gap. |
|
Tier 2 - Non-Preferred Generic Drugs |
$12 |
|
Tier 3 - Preferred Brand Drugs |
$45 |
|
Tier 4 - Non-Preferred Brand Drugs |
$75 |
|
Tier 5 - Specialty Tier Drugs |
33% |
2013 Essential Care (HMO) Plan Documents
2013 Central Ohio Summary of Benefits - HMO Plans
2013 Essential Care (HMO) Evidence of Coverage
2013 Essential Care (HMO) Annual Notice of Changes
2012 Essential Care (HMO) Plan Documents
2012 Essential Care (HMO) Summary of Benefits
2012 Essential Care (HMO) Evidence of Coverage
2012 Essential Care (HMO) Annual Notice of Changes
Last Updated 5/9/2013 3:51:10 PM