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Geisinger Gold Preferred Advantage Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Preferred Advantage Rx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Geisinger Gold Preferred Advantage Rx (PPO) in 2026, please refer to our full plan details page.
Geisinger Gold Preferred Advantage Rx (PPO) is a PPO plan offered by Risant Health, Inc. available for enrollment in 2025 to people living in Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Geisinger Gold Preferred Advantage Rx (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Geisinger Gold Preferred Advantage Rx (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Geisinger Gold Preferred Advantage Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $114.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Geisinger Gold Preferred Advantage Rx (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard mail order services, while standard retail pharmacy copays start as low as $2.00. Additionally, Tier 6 select care drugs are available with no copay for all covered fill lengths through both standard retail pharmacies and mail order. Higher tier medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance for both retail and mail order. Specialty drugs in Tier 5 are covered at a 33% coinsurance for a one-month supply.
Additional Benefits
The Geisinger Gold Preferred Advantage Rx (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for inpatient hospital stays and a daily copay of $200 for the first six days. Primary care doctor visits require a $10 copay, while specialist visits, routine hearing exams, and routine vision exams have copays up to $25 with no coinsurance. Emergency care is available with a $150 copay, and urgent care visits require a $25 copay, with copays waived if you are admitted to the hospital. For specialized care, the plan covers home health services and diagnostic radiological services with no copay, while medical equipment and dialysis require coinsurance ranging up to 20 percent. While Medicare-covered preventive services and certain diagnostic tests are fully covered with no copay, please note that this plan does not cover routine dental cleanings, eyewear, hearing aids, or over-the-counter items.
Inpatient Hospital See details
Geisinger Gold Preferred Advantage Rx (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Geisinger Gold Preferred Advantage Rx (PPO) with no coinsurance, featuring copays of $0 to $250 for outpatient hospital and observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require no coinsurance and copays of $10 for individual or $5 for group sessions.
Partial Hospitalization See details
Geisinger Gold Preferred Advantage Rx (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers ground and air ambulance services with a $200 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers emergency services with a $150 copay and urgently needed services with a $25 copay, with no coinsurance for either benefit and copays waived if you are admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with no coinsurance and copays ranging from $25 to $1,000.
Primary Care See details
Geisinger Gold Preferred Advantage Rx (PPO) covers primary care visits for a $10 copay and specialist visits for a $25 copay, both with no coinsurance. Mental health individual sessions have a $10 copay and group sessions have a $5 copay with no coinsurance, though routine chiropractic services are not covered under this plan.
Preventive Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers Medicare-covered preventive services, kidney disease education, and screenings with no copay and no coinsurance, while an annual physical exam requires a $10 copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance for fitness and remote access, but sub-services such as health education, weight management, nutritional benefits, and home safety assessments are not covered.
Hearing Services See details
Hearing services under Geisinger Gold Preferred Advantage Rx (PPO) cover routine hearing exams and fitting evaluations with a $25 copay, no coinsurance, and no deductible. Although some services are covered, OTC hearing aids and all types of prescription hearing aids—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Geisinger Gold Preferred Advantage Rx (PPO) partially covers vision services, offering routine eye exams with no copay to a $25 copay and no coinsurance. Other eye exam services and all eyewear—including contact lenses, eyeglasses, lenses, frames, and upgrades—are not covered.
Dental Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers Medicare-covered dental services with a $25 copay and no coinsurance, requiring prior authorization. Other dental services, including preventive care like cleanings and exams, as well as comprehensive treatments like restorative and orthodontic services, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Geisinger Gold Preferred Advantage Rx (PPO) with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Preferred Advantage Rx (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. Covered durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Members pay a $15 copay for lab services and diagnostic procedures, a $30 copay for X-rays and therapeutic radiology, and no copay for diagnostic radiological services.
Home Health Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These services require prior authorization and carry copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Geisinger Gold Preferred Advantage Rx (PPO) with no coinsurance, requiring no copay for days 1 to 20 and 46 to 100, and a $160 daily copay for days 21 to 45. Prior authorization is required, a three-day prior hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Geisinger Gold Preferred Advantage Rx (PPO) does not cover Other Services, meaning there is no coverage for acupuncture, over-the-counter (OTC) items, or meal benefits. Since these services are not covered, there are no copayments or coinsurance options available, and members must pay the full cost out of pocket.
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