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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 2026, 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 2026.
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 $7200.00 (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 $7200.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard mail order, while standard pharmacy copays range from $2 to $20 for a one-month supply. Additionally, Tier 6 select care drugs are available with no copay for both standard retail and mail-order options. For higher-tier medications, costs are structured as coinsurance rather than flat copayments. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 34% coinsurance for both standard pharmacy and mail-order fills. Specialty drugs in Tier 5 are covered with a 33% coinsurance for a one-month supply.
Additional Benefits
The Geisinger Gold Preferred Complete Rx (PPO) plan offers comprehensive coverage for core medical services with many benefits requiring no copay and no coinsurance. You will pay no copay for primary care visits, annual physicals, diagnostic radiology, and home health services. For other essential medical needs, costs are structured around predictable copays, such as a $35 copay for specialist visits, a $225 copay for the first six days of inpatient hospital stays, and a $35 copay for routine hearing exams. Outpatient services, emergency care, and diagnostic tests are covered with no coinsurance, though some services require copays, including a $115 copay for emergency room visits and a $20 copay for lab work. For specialized needs like medical equipment and dialysis, you will pay no copay but will be responsible for a coinsurance ranging from 10% to 20%. Note that this plan does not cover routine dental care, eyewear, or hearing aids, meaning you will be responsible for the full cost of those services.
Inpatient Hospital See details
Geisinger Gold Preferred Complete Rx (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as unlimited additional acute days are included, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Geisinger Gold Preferred Complete Rx (PPO) covers outpatient services with no coinsurance, including outpatient blood and ambulatory surgical center services with no copay. Outpatient hospital and observation services require a $0 to $350 copay, while outpatient substance abuse services have a $5 copay for group sessions and a $10 copay for individual sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Geisinger Gold Preferred Complete Rx (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Geisinger Gold Preferred Complete Rx (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, which is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Geisinger Gold Preferred Complete Rx (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency services are covered up to a $100,000 limit with no coinsurance and copays ranging from $35 to $1,000.
Primary Care See details
Geisinger Gold Preferred Complete Rx (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, occupational therapy, and physical therapy services require a $35 copay and no coinsurance. Mental health and psychiatric individual sessions have a $10 copay with no coinsurance, and opioid treatment services feature no copay with a 20% coinsurance.
Preventive Services See details
Geisinger Gold Preferred Complete Rx (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, offering fitness benefits and remote access technologies with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Geisinger Gold Preferred Complete Rx (PPO) hearing services are partially covered, offering routine hearing exams and fitting evaluations for a $35 copay with no coinsurance or deductible. Prescription hearing aids—including inner ear, outer ear, and over-the-ear types—as well as over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Geisinger Gold Preferred Complete Rx (PPO), which features routine eye exams with a copay ranging from no copay to $35 and no coinsurance. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Geisinger Gold Preferred Complete Rx (PPO) provides partial coverage for dental services, covering only Medicare-covered dental benefits with a $35 copay, no coinsurance, and prior authorization required. Routine and comprehensive dental services, including cleanings, exams, x-rays, restorative treatments, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Geisinger Gold Preferred Complete Rx (PPO) with no copay, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Preferred Complete Rx (PPO) plan with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Preferred Complete Rx (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copay and generally a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Geisinger Gold Preferred Complete Rx (PPO) with no coinsurance, though prior authorization is required. Diagnostic procedures and lab services require a $20 copay, outpatient X-rays and therapeutic radiology require a $40 copay, and diagnostic radiology services have no copay.
Home Health Services See details
Home Health Services are covered by Geisinger Gold Preferred Complete Rx (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Geisinger Gold Preferred Complete Rx (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Geisinger Gold Preferred Complete Rx (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 66 through 100, while days 21 through 65 require a $160 daily copay, and additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Other Services are not covered under the Geisinger Gold Preferred Complete Rx (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded.
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