Value Choice (PPO)

MediGold Value Choice (PPO)

MediGold Value Choice (PPO) is a Medicare Advantage Preferred Provider Organization (PPO), which includes Part D prescription drug coverage. This plan is only available in Clark, Greene, Knox, Montgomery and Richland Counties, Ohio. With MediGold Value Choice (PPO), you have the flexibility to use both in-network and out-of-network providers, although you may pay more for out-of-network care, except for urgent or emergent care or out-of-area renal dialysis. 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.

2013	MediGold Value Choice (PPO)
Monthly MediGold Premium	$25
Annual Deductible	$0
Annual Out-of-Pocket Maximum Protection The most you could spend on medical care in 2013	New! $3,200 in-network New! $5,000 combined in-network & out-of-network
Medical Benefits	Your copay:
Doctor Office Visits (Primary Care)	New! $0 in-network & out-of-network
Doctor Office Visits(Specialty Care)	$45 in-network & out-of-network
Lab Tests, Home Health Care, and Medicare-covered Preventive Services	$0 in-network & out-of-network
Hospital Admission	$255 per day for days 1-7; $0 for additional days in-network & out-of-network New! Ask about our inpatient out-of-pocket maximum protection.
Outpatient Diagnostic Test or X-Ray	$45 in-network & out-of-network
Outpatient Surgery	$250 in-network & out-of-network
Diabetic Supplies	0% in-network & out-of-network
Emergency Room Visit	$65 in-network & out-of-network
Prescription Drug Benefits (Part D) You pay no deductibles!	Your copay for a 30-day supply:
Tier 1 - Preferred Generic Drugs	New! $0 Generic drug discounts available 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 MediGold Value Choice (PPO) Plan Documents

2013 MediGold Central Ohio Summary of Benefits - PPO Plans

2013 MediGold Value Choice (PPO) Evidence of Coverage

2013 MediGold Value Choice (PPO) Annual Notice of Changes

2012 MediGold Value Choice (PPO) Plan Documents

2012 MediGold Value Choice (PPO) Summary of Benefits

2012 MediGold Value Choice (PPO) Evidence of Coverage

2012 MediGold Value Choice (PPO) Annual Notice of Changes

Last Updated 4/30/2013 10:22:24 AM

MediGold Value Choice (PPO)

You pay no deductibles!

2013 MediGold Value Choice (PPO) Plan Documents

2012 MediGold Value Choice (PPO) Plan Documents