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Geisinger Gold Preferred Complete Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Preferred Complete 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 Complete Rx (PPO) in 2025, please refer to our full plan details page.
Geisinger Gold Preferred Complete 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 Complete 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 Complete 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 Complete 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 $8000.00 (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 $8000.00 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 Complete Rx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, your costs will vary depending on the drug tier and pharmacy. For instance, you'll pay a $20 copay for preferred generic drugs at a standard pharmacy. You'll pay no copay for preferred generic drugs from a standard mail order pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Geisinger Gold Preferred Complete Rx (PPO) plan offers a wide variety of benefits with varying costs. This plan covers inpatient hospital stays with a copay, and outpatient services, including substance abuse, with copays. Emergency services and ambulance services are covered with copays, and primary care visits have no copay, while specialist visits have a $35 copay. Preventive services, including annual physical exams, have no copay, and hearing and vision services have copays. Dental services are partially covered with a copay for Medicare dental services. The plan also covers home infusion bundled services, dialysis, and medical equipment with coinsurance. Diagnostic and radiological services have copays, and home health services have no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $225 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute are covered, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services and observation services with a copay of $0-$350, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $10 copay for individual sessions and a $5 copay for group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Geisinger Gold Preferred Complete 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 Geisinger Gold Preferred Complete Rx (PPO). Both ground and air ambulance services have a $275 copay, with no coinsurance, and the copay is waived if admitted to the hospital.
Emergency Services See details
Emergency services are covered, with a $110 copay and no coinsurance, and urgently needed services have a $35 copay and no coinsurance. Worldwide emergency services are also covered, with a maximum benefit of $100,000 and copays ranging from $35 to $1000 depending on the service.
Primary Care See details
The Geisinger Gold Preferred Complete Rx (PPO) plan covers primary care physician services with no copay, 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 copay between $5 and $10 depending on the service. The plan also covers podiatry services with a $35 copay for routine foot care, other health care professional services with a copay between $0 and $35, psychiatric services with a copay between $5 and $10 depending on the service, 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.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services, though health education, in-home safety assessments, and other services are not covered. The plan also covers kidney disease education services and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each of which may be optional and require additional payment, and prescription hearing aids and OTC hearing aids are not covered. Routine hearing exams have a $35 copay.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, but eyewear is only partially covered, as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered, with a $35 copay for Medicare Dental Services, but 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, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay with a coinsurance between 0% and 20%. For 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 by the Geisinger Gold Preferred Complete Rx (PPO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 0-20% coinsurance for covered services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for all services. Diagnostic Procedures/Tests and Lab Services have a $20 copay, Diagnostic Radiological Services have a copay of at most $290, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Preferred Complete 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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. There is no copay for days 1-20, a $160 copay for days 21-70, and no copay for days 71-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered, including 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. No authorization or referrals are required.
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