MediGold Cash Back No Premium MA Only (HMO) H9827-003 is a 2023 Medicare Advantage Plan or Part-C by MediGold available to residents in New York. This plan does not provide extra prescription drug (Part-D) coverage. MediGold MediGold Cash Back No Premium MA Only (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,800 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay
$4,800 out-of-pocket. This can be an extremely nice safety net.
MediGold works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MediGold Cash Back No Premium MA Only (HMO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance)
and Part B (Medical Insurance) coverage from MediGold and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all
the benefits of Original Medicare from MediGold except hospice care. Original Medicare still provides you with hospice care if you sign up for
Medicare Advantage in New York.
What type of plan is MediGold Cash Back No Premium MA Only (HMO)
MediGold Cash Back No Premium MA Only (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.
How much does MediGold Cash Back No Premium MA Only (HMO) cost?
Part-C Premium
A monthly premium is the fee you pay to the plan in exchange for coverage. MediGold charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
MOOP
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. MediGold Cash Back No Premium MA Only (HMO) by MediGold MOOP is $4,800. Once you spend $4,800 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.
2023 Summary of Benefits
The benefit information provided is a summary of what MediGold Cash Back No Premium MA Only (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from MediGold helps
get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
$0 per day for days 1 through 20 $196 per day for days 21 through 58 $0 per day for days 59 through 100
Occupational therapy visit
Rehabilitation services
$25 copay
Physical therapy and speech and language therapy visit
Rehabilitation services
$25 copay
Cleaning
Preventive dental
$0 copay
Dental x-ray(s)
Preventive dental
$0 copay
Fluoride treatment
Preventive dental
$0 copay
Oral exam
Preventive dental
$0 copay
Preventive care
$0 copay
Outpatient hospital coverage
$0-200 copay per visit
In-Network Other health plan deductibles?
No
Optional supplemental benefits
Yes
Inpatient hospital - psychiatric
Mental health services
$250 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit
Mental health services
$25 copay
Outpatient group therapy visit with a psychiatrist
Mental health services
$25 copay
Outpatient individual therapy visit
Mental health services
$25 copay
Outpatient individual therapy visit with a psychiatrist
Mental health services
$25 copay
Chemotherapy
Medicare Part B drugs
20% coinsurance
Other Part B drugs
Medicare Part B drugs
20% coinsurance
Diabetes supplies
Medical equipment/supplies
$0 copay per item
Durable medical equipment (e.g., wheelchairs, oxygen)
Medical equipment/supplies
20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)
Medical equipment/supplies
20% coinsurance per item
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$4,800 In-network
Inpatient hospital coverage
$250 per day for days 1 through 5 $0 per day for days 6 through 90
Fitting/evaluation
Hearing
$0 copay
Hearing aids
Hearing
$399-699 copay
Hearing exam
Hearing
$25 copay
Health plan deductible
$0
Ground ambulance
$150 copay
Foot exams and treatment
Foot care (podiatry services)
$25 copay
Routine foot care
Foot care (podiatry services)
Not covered
Emergency
Emergency care/Urgent care
$90 copay per visit (always covered)
Urgent care
Emergency care/Urgent care
$25 copay per visit (always covered)
Primary
Doctor visits
$0 copay
Specialist
Doctor visits
$25 copay per visit
Diagnostic radiology services (e.g., MRI)
Diagnostic procedures/lab services/imaging
$125 copay
Diagnostic tests and procedures
Diagnostic procedures/lab services/imaging
$0-25 copay
Lab services
Diagnostic procedures/lab services/imaging
$0 copay
Outpatient x-rays
Diagnostic procedures/lab services/imaging
$0 copay
Diagnostic services
Comprehensive dental
$0 copay
Endodontics
Comprehensive dental
70% coinsurance
Extractions
Comprehensive dental
50% coinsurance
Non-routine services
Comprehensive dental
Not covered
Periodontics
Comprehensive dental
70% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
Comprehensive dental
Not covered
Restorative services
Comprehensive dental
50% coinsurance
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
No
Coverage Area
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for MediGold Cash Back No Premium MA Only (HMO) requires you to live in that plan’s service area. The service area is listed below:
How much does MediGold Cash Back No Premium MA Only (HMO) cost?
MediGold charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
How much is MediGold Cash Back No Premium MA Only (HMO) MOOP?
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. MediGold Cash Back No Premium MA Only (HMO) by MediGold MOOP is $4,800. Once you spend $4,800 you will pay nothing for Part A or Part B covered services.
What type of plan is MediGold Cash Back No Premium MA Only (HMO)?
MediGold Cash Back No Premium MA Only (HMO) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
Site Search:
MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.
