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MediGold Medical Only (HMO)

MediGold Medical Only (HMO) is a Medicare Advantage Health Maintenance Organization (HMO). The chart below provides a summary of the benefits available with this plan. You may also find it helpful to review the Evidence of Coverage and Summary of Benefits documents. They provide information about this plan option in more detail.

2014

MediGold Medical Only (HMO)

Monthly MediGold Premium

$45

Annual Deductible

$0

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

$3,200

Medical Benefits

Your copay:

Doctor Office Visits  (Primary Care)

$0

Doctor Office Visits(Specialty Care)

$30

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

$0

Hospital Admission

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

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

Outpatient Diagnostic Test or X-Ray

$40

Outpatient Surgery

$125

Diabetic Supplies

0%

Emergency Room Visit

$65

Prescription Drug Benefits (Part D)
 

Part D not included

 

2014 MediGold Medical Only (HMO) Plan Documents

2014 MediGold Central Ohio Summary of Benefits - HMO Plans

2014 MediGold Medical Only (HMO) Evidence of Coverage

Last Updated 1/2/2014 3:52:57 PM