Mount Carmel MediGold Plus (HMO) Medicare Advantage Plan H3668-022 • 2027 • Pickaway County, OH
- Monthly Premium
- $49.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4500.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $250.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Pickaway County, OH
- Local Enrollment
- 34 beneficiaries in Pickaway County
Mount Carmel MediGold Plus (HMO) Introduction
Mount Carmel MediGold Plus is a Medicare Advantage HMO plan offered by MediGold. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $49.00 monthly premium, $0.00 medical deductible, and $4500.00 in-network maximum out-of-pocket. CMS Plan ID H3668-022 identifies this plan. The 2027 Part D prescription drug deductible is $250.00.
This plan is available to eligible residents of Pickaway County, Ohio. CMS reports 34 beneficiaries enrolled in this plan in Pickaway County. For assistance with this plan, new members can call (800)964-4525 (TTY 711).
Compare Similar Plans in Pickaway County
Compare this plan with the two most-enrolled HMO plans available in Pickaway County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | Mount Carmel MediGold Plus | Mount Carmel MediGold Premier | Mount Carmel MediGold No Premium |
|---|---|---|---|
| CMS Plan ID | H3668-022-0 |
H3668-018-1 |
H3668-019-1 |
| Local Enrollment | 34 | 637 | 602 |
| Monthly Premium | $49.00 | $109.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $4,500.00 | $3,900.00 | $5,900.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $30 copay | $35 copay |
| Part D Deductible | $250.00 | $0.00 | $275.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Mount Carmel MediGold Plus has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3668-022.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3668-022-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $35 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$35 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $125 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $20 copay
- Diagnostic tests and procedures
- In-network: $20 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$221 per day for days 21-65
$0 per day for days 66-100 - Ground ambulance
- In-network: $200 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $30 copay
- Outpatient group therapy
- In-network: $30 copay
- Inpatient psychiatric hospital care
- Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
- Occupational therapy
- In-network: $40 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: 70% coinsurance
- Endodontics
- In-network: 70% coinsurance
- Restorative services
- In-network: 50% coinsurance
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $599-$899 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Mount Carmel MediGold Plus as a Part B benefit.
Prescription Drug Coverage
Mount Carmel MediGold Plus includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $36.50 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $36.50 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $21.10 |
| Low-Income Subsidy Premium: | $15.40 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before MediGold starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Mount Carmel MediGold Plus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $10.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3668)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for MediGold
- Website
- MediGold Plan Page
- Providers
- MediGold Providers Page
- Formulary
- MediGold Formulary Page
- Pharmacy
- MediGold Pharmacy Page
- New Member Health Plan Help
- (800)964-4525
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)964-4525
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| MediGold (official source) | http://www.thpmedicare.org/mount-carm | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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