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Geisinger Gold Preferred Enhanced Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Preferred Enhanced 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 Enhanced Rx (PPO) in 2025, please refer to our full plan details page.
Geisinger Gold Preferred Enhanced 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 Enhanced 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 Enhanced 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 Enhanced Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $7550.00 (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 $7550.00 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 Enhanced Rx (PPO) plan has no deductible for prescription drugs. During the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, and no copay for preferred generic drugs through standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for covered Part D drugs. This plan may have a reduced premium if you qualify for the low-income subsidy, also known as LIS or "Extra help". If you qualify for LIS, your Part D premium will be $35.00.
Additional Benefits
The Geisinger Gold Preferred Enhanced Rx (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $305. The plan also covers emergency services, primary care, preventive services, and vision services with varying copays. Additionally, this plan includes dental services with a $35 copay for Medicare-covered services, and up to $1,000 per year for other dental work. This plan provides coverage for hearing exams, hearing aids, and offers a $25 quarterly allowance for over-the-counter items. Home health and skilled nursing facility services are covered with no copay for some days of coverage. The plan also covers ambulance and transportation services, dialysis services, and medical equipment with copays or coinsurance, while some services like cardiac rehabilitation and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Geisinger Gold Preferred Enhanced Rx (PPO) plan. For Inpatient Hospital-Acute, you will pay a $165 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $165 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $305, and observation services with a copay between $0 and $305. Ambulatory Surgical Center (ASC) Services have no copay, while individual and group sessions for outpatient substance abuse have a copay of $10 and $5, respectively. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Preferred Enhanced Rx (PPO) plan. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a copay between $275 and $1000.
Primary Care See details
Geisinger Gold Preferred Enhanced Rx (PPO) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services with a $10 copay for individual sessions and a $5 copay for group sessions. The plan also covers podiatry services with a $35 copay for routine foot care, other health care professionals with a copay between $0 and $35, psychiatric services with a $10 copay for individual sessions and a $5 copay for group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional services like fitness benefits have a copay between $10 and $25, while services such as health education, counseling services, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay. Routine hearing exams are covered for 1 visit per year with a copay of $20. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $165 per year, and 2 hearing aid fittings per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$35, and routine eye exams with a $20 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay. Other dental services are covered up to a maximum of $1,000 per year, including oral exams with 2 visits per year, dental x-rays, prophylaxis (cleaning) with 2 visits per year, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. However, fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Preferred Enhanced Rx (PPO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance for Medicare-covered items, while Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Geisinger Gold Preferred Enhanced Rx (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests and lab services, with a $10 copay. Diagnostic radiological services have a copay of at most $235, and therapeutic radiological services have a copay of at most $60, while outpatient X-ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Preferred Enhanced 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 Enhanced Rx (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Preferred Enhanced Rx (PPO) plan. For days 1-20, there is no copay, for days 21-68 the copay is $160, and for days 69-100 there is no copay.
Other Services See details
The Geisinger Gold Preferred Enhanced Rx (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $25.00 every three months. Acupuncture, Meal Benefit, 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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