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 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 $103.00. 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:
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you may pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you may pay a $20 copay at a standard pharmacy for preferred generic drugs. During the initial coverage phase, you will pay costs for drugs until your total drug costs reach $2000. After this, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers a wide range of benefits with varying costs. You will pay a copay for inpatient hospital stays, emergency services, and outpatient services. The plan also covers primary care, preventive, vision, hearing, and dental services, each with its own cost structure. The plan includes coverage for ambulance, home health, and skilled nursing facility services, as well as home infusion and dialysis. The plan also covers durable medical equipment, diagnostic and radiological services. However, certain services like cardiac rehabilitation, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $150 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a copay between $0 and $200, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services. Individual Sessions for Outpatient Substance Abuse have a $10 copay, while Group Sessions have a $5 copay. 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. The copay for this benefit is $25.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $100 copay and no coinsurance, and the copay is waived if admitted to the hospital. 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 by the Geisinger Gold Classic Advantage Rx (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $20 copay, and Worldwide Emergency Transportation has a copay between $100 and $1000; all services have no coinsurance.
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, and mental health specialty services with a $10 copay for individual sessions and a $5 copay for group sessions. The plan also covers podiatry services with a $20 copay for Medicare-covered services and routine foot care, other health care professional services with a copay between $0 and $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 a copay between $0 and $20, and opioid treatment program services with a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Fitness benefit is covered with a maximum plan benefit coverage amount of $90.00 every three months for Memory Fitness. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and prescription hearing aids are covered with a $500 copay for all types, up to $1250 every three years, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Geisinger Gold Classic Advantage Rx (HMO) plan covers vision services, including eye exams with a copay of $0-$20 for Routine Eye Exams, and eyewear. Eyewear has a combined maximum benefit of $200 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are unlimited. Upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $20 copay, and other dental services with a maximum plan benefit of $1250 per year. Oral exams and teeth cleanings are covered for 2 visits per year, while 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 by the Geisinger Gold Classic Advantage Rx (HMO) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
The Geisinger Gold Classic Advantage Rx (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization. Prosthetic Devices have a 20% coinsurance, while 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 are covered, including diagnostic procedures and tests with a $5 copay, and lab services with a $5 copay. Diagnostic radiological services have a copay of at least $25, up to $150, and therapeutic radiological services have a copay of at least $25, up to $60. Outpatient X-Ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan with no copay and no coinsurance, but prior authorization is required. 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 Classic Advantage Rx (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. There is no copay for days 1-20, a $160 copay for days 21-42, and no copay for days 43-100.
Other Services See details
Other Services are not covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. The plan does not cover 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.
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