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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 2025, 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 2025.
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 $97.00. 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different costs depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will have no copay for preferred generic drugs through standard mail, but a $20 copay through a standard pharmacy. For specialty tier drugs, you will have no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Geisinger Gold Preferred Advantage Rx (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $200 copay for the first 6 days, and no copay for days 7-90. Outpatient services have copays that range from $0 to $250, and primary care visits cost $10. This plan provides coverage for preventive services with no copay for Medicare-covered services, and also includes hearing and vision benefits, as well as dental services. Ambulance services have a $200 copay, while emergency services have a $140 copay. Additionally, the plan covers home health services with no copay, and skilled nursing facility services with no copay for certain days.
Inpatient Hospital See details
Inpatient hospital services are covered, including inpatient hospital-acute and inpatient hospital psychiatric. For the first 6 days, there is a $200 copay, and for days 7-90, there is no copay. Additional days for inpatient hospital-acute are covered, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, along with additional days and non-Medicare-covered stays for inpatient hospital psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a copay between $0 and $250, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $10 copay for individual sessions and a $5 copay for group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Geisinger Gold Preferred Advantage Rx (PPO). Both ground and air ambulance services have a $200 copay. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay; both have no coinsurance. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a copay between $200 and $1000.
Primary Care See details
The Geisinger Gold Preferred Advantage Rx (PPO) plan covers primary care physician services with a $10 copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a $25 copay. Physician specialist services have a $25 copay. Individual and group sessions for mental health specialty services have copays of $10 and $5, respectively. Podiatry services have a $25 copay for routine foot care. Other health care professional services have a copay between $0 and $25. Individual and group sessions for psychiatric services have copays of $10 and $5, respectively. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $5 and $25. Opioid treatment program services have 20% coinsurance.
Preventive Services See details
The Geisinger Gold Preferred Advantage Rx (PPO) plan covers preventive services, including Medicare-covered services with no copay, an annual physical exam with a $10 copay, and other services like Glaucoma Screening and Diabetes Self-Management Training. However, services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $25, and no coinsurance. Eyewear coverage is partially covered, as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. Medicare Dental Services are covered with a $25 copay, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. You will pay between 10% and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance, and Prosthetic Devices and Medical Supplies also subject to a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests and Lab Services have a $15 copay, while Diagnostic Radiological Services have a copay between $30 and $275, and Therapeutic Radiological Services have a copay between $30 and $60. Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan with no copay or coinsurance, but authorization is required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. This plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $160; and for days 46-100, there is no copay.
Other Services See details
Other services, including acupuncture, over-the-counter items, meal benefits, and several others, are not covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. No authorization or referrals are required for any of the services.
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