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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 $82.00. 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 will pay varying costs depending on the drug tier and pharmacy. For example, in the standard pharmacy, you will pay a $20 copay for preferred generic drugs and 25% coinsurance for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy, your monthly premium will be reduced to $19.00.
Additional Benefits
The Geisinger Gold Preferred Advantage Rx (PPO) plan offers coverage for a variety of services. You can expect a $200 copay for inpatient hospital stays for days 1-6, and no copay for days 7-90. Primary care visits cost $10, specialist visits cost $25, and emergency services have a $140 copay. Preventive services are covered with no copay for Medicare-covered services, and an annual physical exam has a $10 copay. Dental and vision services are partially covered, and hearing exams have a $25 copay. Other services such as home health, skilled nursing facility, and ambulance services are covered with varying cost-sharing amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $200 for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services with a copay between $0 and $250, ambulatory surgical center services with no copay, and individual sessions for outpatient substance abuse with a $10 copay and group sessions with a $5 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. Ground and Air Ambulance Services have a $200 copay, with no coinsurance, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgent services have a $25 copay and no coinsurance, while worldwide emergency coverage has a $140 copay, worldwide urgent coverage has a $25 copay, and worldwide emergency transportation has a $200-$1000 copay, with no coinsurance for any of these services.
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 for routine care, while occupational therapy services have a $25 copay. Specialist visits cost $25, and physical therapy and speech-language pathology services also have a $25 copay. Mental health and psychiatric services have varying copays, with individual sessions costing $10 and group sessions costing $5. Podiatry services, other health care professional visits, and additional telehealth benefits have varying copays, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Geisinger Gold Preferred Advantage Rx (PPO) plan covers preventive services, including Medicare-covered services with no copay, and an annual physical exam with a $10 copay. Additional preventive services are partially covered, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, but prescription hearing aids and OTC hearing aids are not covered. Fitting/evaluation for hearing aids is covered as an optional, supplemental benefit; contact the plan for details.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $25, and does not have a deductible. Eyewear coverage is partially covered, with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades not covered.
Dental Services See details
Dental Services are partially covered under 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, including Medicare Part B Insulin Drugs with a $35 copay, and a coinsurance between 0-20% for all Medicare Part B drugs. Prior authorization is required.
Dialysis Services See details
Dialysis services are covered under the Geisinger Gold Preferred Advantage Rx (PPO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. For Durable Medical Equipment, there is a 20% coinsurance and no copay, while equipment for use outside of the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 0-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $15 copay, Lab Services with a $15 copay, Diagnostic Radiological Services with a copay between $30 and $275, Therapeutic Radiological Services with a copay between $30 and $60, and Outpatient X-Ray Services with a $30 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan with no copay and no coinsurance, but authorization is required. 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. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan, but require prior authorization. For days 1-20 and 46-100, there is no copay, while days 21-45 have a $160 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Geisinger Gold Preferred Advantage Rx (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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