MediGold Classic Preferred (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by MediGold
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.5
out of 5 stars

State: Ohio

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$120
$79
$41
$0
$3,900 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

$5 per visit
$45 per visit

Tests, labs, & imaging

$20
$0 copay
$50
$20
$90 per visit (always covered)
$40 per visit (always covered)

Hospital Services

$190 per day for days 1 through 4
$0 per day for days 5 through 90
$45-125 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$178 per day for days 21 through 47
$0 per day for days 48 through 100

Preventive services

$0 copay

Ambulance

$200

Therapy services

$40
$40

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

20% per item
20% per item
$0 per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$5.00 copay
Preferred Brand$45.00 copay
Non-Preferred Drug$75.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

20%
20%

Extra Benefits

Hearing

$45
$0 copay
$499-799

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$0 copay
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 4
 3
 3
 5
 5
 5
 5
 5
 5
 4
 4

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