A non-government entity
Geisinger Gold Classic Advantage Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Classic Advantage Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Geisinger Gold Classic Advantage Rx (HMO) in 2026, please refer to our full plan details page.
Geisinger Gold Classic Advantage Rx (HMO) is a HMO 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 Classic Advantage Rx (HMO) 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 Classic Advantage Rx (HMO).
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 Classic Advantage Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $135.90. 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 Maximum Out-Of-Pocket cost of $3450.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Sign up for Geisinger Gold Classic Advantage Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Geisinger Gold Classic Advantage Rx (HMO) 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 $5 for Tier 1 and $20 to $50 for Tier 2. Additionally, Tier 6 select care drugs require no copay for any supply filled through standard pharmacies or mail order. For brand-name and specialty medications, costs are based on coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 37% coinsurance for both standard pharmacy and mail order options. Specialty Tier 5 drugs have a 33% coinsurance for a one-month supply.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers robust coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $150 daily copay for days one through five and no copay for days six through ninety, with no coinsurance. Outpatient services and specialist visits are also highly affordable, featuring low copays ranging from no copay to $200 and no coinsurance. Emergency and ambulance services require a $150 and $100 copay respectively, both of which are waived upon hospital admission. Routine dental, vision, and hearing services are covered with low copays, including a $200 annual eyewear allowance and up to $1,250 in dental benefits. While medical equipment and dialysis services require a 10% to 20% coinsurance, most other covered services feature predictable copays and no coinsurance.
Inpatient Hospital See details
Geisinger Gold Classic Advantage Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $150 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization is required, and while unlimited additional acute days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Geisinger Gold Classic Advantage Rx (HMO) are covered with no coinsurance, featuring a $0 to $200 copay for outpatient hospital and observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services also have no coinsurance, with a $10 copay for individual sessions and a $5 copay for group sessions.
Partial Hospitalization See details
Geisinger Gold Classic Advantage Rx (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers Medicare-approved ground and air ambulance services with a $100 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Geisinger Gold Classic Advantage Rx (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services have a $20 copay and no coinsurance, while worldwide emergency services are covered up to a $100,000 maximum with no coinsurance and copays ranging from $20 to $1,000.
Primary Care See details
Geisinger Gold Classic Advantage Rx (HMO) covers primary care physician services with no copay and no coinsurance, while specialists, podiatry, and therapy services require a $20 copay and no coinsurance. Mental health and psychiatric sessions carry a $5 to $10 copay with no coinsurance, and telehealth benefits range from no copay to a $20 copay with no coinsurance. Opioid treatment is covered with no copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Geisinger Gold Classic Advantage Rx (HMO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and remote access technologies. A memory fitness benefit is also covered with no copay and no coinsurance up to $90 every three months. However, several supplemental services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Geisinger Gold Classic Advantage Rx (HMO), which offers routine hearing exams and fitting evaluations for a $20 copay and no coinsurance. While some prescription hearing aid services are covered with a $500 copay and no coinsurance, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Geisinger Gold Classic Advantage Rx (HMO), which offers one annual routine eye exam with a $20 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $200 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Geisinger Gold Classic Advantage Rx (HMO) partially covers dental services with a $20 copay and no coinsurance for Medicare-covered services, and no copay and no coinsurance for other covered services up to a $1,250 annual maximum. Covered benefits include exams, cleanings, and x-rays, while fluoride, implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with no copay and a coinsurance of 10% to 20%.
Medical Equipment See details
Geisinger Gold Classic Advantage Rx (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a prior authorization requirement. Members will pay a 20% coinsurance for most equipment and supplies, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Outpatient lab services and diagnostic tests require a $5 copay, outpatient X-rays and therapeutic radiological services have a $25 copay, and diagnostic radiological services have no copay (minimum $0 copay).
Home Health Services See details
Home health services are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, but only some services are covered in practice because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Classic Advantage Rx (HMO) covers skilled nursing facility (SNF) services 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 43 through 100, a $160 daily copay for days 21 through 42, 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 Classic Advantage Rx (HMO) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved