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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 $96.00. 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 drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, standard mail order offers no copay for up to a three-month supply, while standard pharmacies charge low copays starting at $2.00 and $20.00 respectively for a one-month supply. Additionally, Tier 6 select care drugs are available with no copay through both standard pharmacies and standard mail order. Brand-name and specialty medications on higher tiers transition to coinsurance costs rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, Tier 4 non-preferred drugs require 31% coinsurance, and Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply. These coinsurance rates apply to both standard retail pharmacy and standard mail order options.
Additional Benefits
The Geisinger Gold Preferred Advantage Rx (PPO) plan offers comprehensive medical coverage with no coinsurance for inpatient hospital stays, outpatient services, and doctor visits. Members can expect a $200 daily copay for the first six days of inpatient care, a $10 copay for primary care visits, and a $25 copay for specialist visits. Emergency services carry a $150 copay, which is waived if admitted, while most preventive services are covered with no copay and no coinsurance. Routine hearing, vision, and Medicare-covered dental exams are available with copays ranging from no copay to $25, though hearing aids, eyewear, and routine dental care are excluded. Diagnostic tests, home health care, and skilled nursing stays are covered with minimal costs, featuring no coinsurance and mostly no copays. However, durable medical equipment and dialysis services require a 20% and 10% to 20% coinsurance, respectively, with no copays.
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. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $0 to $250 copay for outpatient hospital and observation services. Outpatient substance abuse services are also covered with no coinsurance, requiring a copay of $5 for group sessions and $10 for individual sessions.
Partial Hospitalization See details
Geisinger Gold Preferred Advantage Rx (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers Medicare-covered ground and air ambulance services with a $200 copay and no coinsurance, which is 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, both featuring no coinsurance and waived copays if admitted to the hospital within 3 days. Worldwide emergency services are also covered up to a $100,000 maximum with no coinsurance and copays ranging from $25 to $1,000 depending on the service.
Primary Care See details
Geisinger Gold Preferred Advantage Rx (PPO) covers primary care visits for a $10 copay and specialist and therapy visits for a $25 copay, all with no coinsurance. Mental health and psychiatric individual sessions carry a $10 copay (group sessions are $5) with no coinsurance, while chiropractic services are not covered. Opioid treatment is available with no copay and 20% coinsurance, and telehealth benefits range from a $5 to $25 copay with no coinsurance.
Preventive Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers preventive services, including kidney disease education and screenings, with no copay and no coinsurance, though an annual physical exam requires a $10.00 copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, and therapeutic massage. Also excluded from coverage are adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling services.
Hearing Services See details
Hearing services are partially covered by Geisinger Gold Preferred Advantage Rx (PPO), which offers routine hearing exams and fitting evaluations for a $25 copay with no coinsurance or deductible. However, both prescription and over-the-counter (OTC) hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Geisinger Gold Preferred Advantage Rx (PPO), which features routine eye exams with a $0 to $25 copay, no deductible, and no coinsurance, while other eye exam services are not covered. Eyewear is not covered under this plan, as contact lenses, eyeglasses, lenses, frames, and upgrades are all excluded.
Dental Services See details
Geisinger Gold Preferred Advantage Rx (PPO) partially covers dental services, offering Medicare-covered dental care for a $25.00 copay and no coinsurance, though prior authorization is required. Routine and comprehensive dental services, including exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, and oral surgery, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Geisinger Gold Preferred Advantage Rx (PPO) with no copay, though prior authorization and step therapy apply. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Preferred Advantage Rx (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and a 20% coinsurance. Diabetic supplies range from no coinsurance to 20% coinsurance, and prior authorization is required for these covered benefits.
Diagnostic and Radiological Services See details
Geisinger Gold Preferred Advantage Rx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members will pay a $15 copay for lab services and diagnostic procedures, a $30 copay for outpatient X-rays and therapeutic radiological services, and no copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Preferred Advantage Rx (PPO) covers skilled nursing facility care with no coinsurance, requiring no copay for days 1 through 20 and days 46 through 100, and a $160 daily copay for days 21 through 45. Prior authorization is required, but a three-day prior hospital stay is not, and additional days beyond the Medicare-covered 100-day benefit period are not covered.
Other Services See details
Other services are not covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan, which excludes coverage for acupuncture, over-the-counter (OTC) items, and meal benefits. Because these services are not covered, members are responsible for the full cost of these services out-of-pocket.
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