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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 2025, 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 2025.
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 $127.00. 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 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:
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Drug Coverage
The Geisinger Gold Classic Advantage Rx (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy used. For example, you will pay a $20 copay at a standard pharmacy for preferred generic drugs, or 10% coinsurance for standard generic drugs through the mail. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D-covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a premium of $45.70.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. This plan also covers ambulance, emergency, and primary care services, as well as preventive, hearing, vision, and dental services, all with associated copays or coinsurance. Additionally, the plan provides coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services, each with specific cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $150 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $150 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$200, Observation Services with a copay of $0-$200, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a copay of $10 for Individual Sessions and $5 for Group Sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Geisinger Gold Classic Advantage Rx (HMO) plan, but requires prior authorization. You will have a $25 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. Ground and Air Ambulance Services have a $100 copay, and there is no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgently Needed Services have a $20 copay with no coinsurance, and Worldwide Emergency Services are covered with copays ranging from $20 to $1000 depending on the service, and are subject to a maximum benefit of $100,000.
Primary Care See details
The Geisinger Gold Classic Advantage Rx (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, mental health specialty services with a $10 copay for individual sessions and a $5 copay for group sessions, podiatry services with a $20 copay for Medicare-covered services and routine foot care, other health care professional services with copays ranging from $0 to $20, psychiatric services with a $10 copay for individual sessions and a $5 copay for group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with copays ranging from $0 to $20, and opioid treatment program services with 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and other preventive services are covered. The plan also covers Fitness Benefit, with a maximum plan benefit coverage amount of $90.00 every three months, and Remote Access Technologies. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing exams are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with a $20 copay, and routine hearing exams are limited to one per year. Prescription hearing aids are covered up to $1250 every three years, with a $500 copay for all types of prescription hearing aids.
Vision Services See details
The Geisinger Gold Classic Advantage Rx (HMO) plan covers vision services, including routine eye exams with a $20 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $200 per year, but upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $20 copay, oral exams (2 visits per year), dental x-rays, prophylaxis (cleaning) (2 visits per year), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, with a maximum plan benefit of $1250 per year. 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. The coinsurance for these services ranges from 10% to 20%.
Medical Equipment See details
Medical equipment is covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices have a 20% coinsurance; Medical Supplies have a 20% coinsurance; Diabetic Supplies have between 0% and 20% coinsurance; and 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 $5 copay; diagnostic radiological services have a copay between $25 and $150, while therapeutic radiological services have a copay between $25 and $60, and outpatient x-rays have a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-42, the copay is $160, and for days 43-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The "Other Services" benefit for the Geisinger Gold Classic Advantage Rx (HMO) plan does not cover acupuncture, over-the-counter items, a meal benefit, 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. No authorization or referrals are required for the covered services.
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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.
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