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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3668-019 Cross-check on Medicare.gov →

Mount Carmel MediGold No Premium (HMO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$150.00 Annual Deductible
994 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 Omeprazole Brand Tier 1 $0.00 Details
2 Diazepam Brand Tier 2 $0.00 Details
3 Lenalidomide Brand Tier 5 $0.00 Details
4 SCEMBLIX asciminib Brand Tier 5 $0.00 Details
5 Xalkori CRIZOTINIB Brand Tier 5 $0.00 Details
6 JAYPIRCA pirtobrutinib Brand Tier 5 $0.00 Details
7 Mercaptopurine Brand Tier 3 $0.00 Details
8 Dicloxacillin Sodium Brand Tier 3 $0.00 Details
9 Loxapine Brand Tier 3 $0.00 Details
10 Perphenazine perphenazine Brand Tier 3 $0.00 Details
11 LACTULOSE Lactulose Brand Tier 2 $0.00 Details
12 Nortriptyline Hydrochloride Brand Tier 4 $0.00 Details
13 Verzenio abemaciclib Brand Tier 5 $0.00 Details
14 Scopolamine scopolamine Brand Tier 4 $0.00 Details
15 Spiriva Respimat tiotropium bromide inhalation spray Brand Tier 4 $0.00 Details
16 Chlorpromazine Hydrochloride Brand Tier 4 $0.00 Details
17 Xospata gilteritinib Brand Tier 5 $0.00 Details
18 Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate Brand Tier 4 $0.00 Details
19 Xtandi enzalutamide Brand Tier 5 $0.00 Details
20 Sulfasalazine Brand Tier 2 $0.00 Details

Showing 20 of 994 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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