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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 $0.00. 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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you may pay a $10 copay for preferred generic drugs at a standard pharmacy, or 10% coinsurance for standard generic drugs through mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. The plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Geisinger Gold Preferred Enhanced Rx (PPO) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $305, and emergency services with a $110 copay. Primary care, including specialist visits, chiropractic, and therapy services, generally have a $15-$35 copay. Preventive, hearing, vision, and dental services are included, with specific copays and maximum benefits for hearing aids, eyewear, and dental care. Additional benefits include home infusion, dialysis with coinsurance, medical equipment with coinsurance, and diagnostic services. The plan also covers skilled nursing facility stays with copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you pay a $165 copay for days 1-5, and no copay for days 6-90, while additional days are covered with no copay. For Inpatient Hospital Psychiatric, you 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 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, also with a copay between $0 and $305. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services are covered 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, but requires prior authorization. You will pay a $55 copay for this service.
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, but 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 have 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, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered but require prior authorization, with individual sessions for both mental health and psychiatric services having a $10 copay, and group sessions having a $5 copay; Opioid Treatment Program Services have a 20% coinsurance. Additional Telehealth benefits are covered with a copay between $0 and $35. Podiatry Services are covered, including routine foot care with a $35 copay. Other Health Care Professional services are covered with a copay between $0 and $35.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered. Additional preventive services include a Fitness Benefit with a copay between $10 and $25, while services like Health Education, In-Home Safety Assessment, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered for one visit per year with a copay of $20. Prescription hearing aids are covered, with a maximum benefit of $125 per year for both in-network and out-of-network services. Prescription hearing aids are covered for 2 visits per year.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$35, routine eye exams with a $20 copay, and eyewear with a combined maximum benefit of $125 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, but upgrades are not.
Dental Services See details
Dental Services includes 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. The plan does not cover fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics. The plan has a $1000 maximum benefit per year for in-network and out-of-network services.
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. Insulin has a $35 copay and 0-20% coinsurance. Other services have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by 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 is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, but no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and lab services, are covered with a $10 copay, while diagnostic radiological services have a copay up to $235 (minimum $35), therapeutic radiological services have a copay up to $60 (minimum $35), and outpatient X-ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by Geisinger Gold Preferred Enhanced Rx (PPO) with no copay and no coinsurance. 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 by the Geisinger Gold Preferred Enhanced Rx (PPO) plan, with a prior authorization requirement. 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. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $25 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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