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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 $76.00. 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 a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, Tier 1 drugs have a $0 copay at a standard mail pharmacy, while Tier 2 drugs have a 10% coinsurance at a standard mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you'll pay $41.00.
Additional Benefits
The Geisinger Gold Preferred Enhanced Rx (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance and emergency services with copays. Primary care, preventive, vision, and dental services are also covered, with some services requiring copays. The plan also covers home infusion, dialysis services, and medical equipment with coinsurance, along with diagnostic and radiological services and home health services with no copay. Additional benefits include hearing services, skilled nursing facility stays with varying copays, and other services such as over-the-counter items with a quarterly benefit. However, the plan does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5, there is a $165 copay, and for days 6-90, there is no copay. 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 copays ranging from $0 to $305. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services include individual sessions 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 by the Geisinger Gold Preferred Enhanced Rx (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
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, with no coinsurance, and 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 under the Geisinger Gold Preferred Enhanced Rx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a copay between $275 and $1000. Worldwide Urgent Coverage has a $35 copay. There is no coinsurance for any of these services.
Primary Care See details
The Geisinger Gold Preferred Enhanced Rx (PPO) plan 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, mental health specialty services, podiatry services with a $35 copay for routine foot care (limited to 4 visits per year), other health care professional services with a copay between $0 and $35, psychiatric services, 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, including Medicare-covered services, are covered by the Geisinger Gold Preferred Enhanced Rx (PPO) plan. Additional preventive services may have a copay, and fitness benefits have a copay between $10 and $25; however, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams (1 per year) with a copay of $20, fitting/evaluation for hearing aids, and prescription hearing aids (all types), with a maximum benefit of $125 per year, but do not cover prescription hearing aids for the inner ear, outer ear, or over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$35, and routine eye exams with a $20 copay. Eyewear is covered with a combined maximum benefit of $125 per year, and 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, oral exams (2 per year), dental X-rays, prophylaxis (cleaning, 2 per year), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. 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. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Preferred Enhanced Rx (PPO) plan. The coinsurance for these services ranges from 10% to 20%.
Medical Equipment See details
Medical Equipment benefits are covered, with a 20% coinsurance for Durable Medical Equipment (DME) and a 20% coinsurance for Prosthetic Devices and Medical Supplies. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered with a $10 copay. Diagnostic Radiological Services have a copay up to $235, Therapeutic Radiological Services have a copay up to $60, and 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 prior 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. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under 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
Other Services for the Geisinger Gold Preferred Enhanced Rx (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $25.00 every three months, which does not carry over if unused, but does not cover acupuncture, 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, or Self-Directed Personal Assistance Services.
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