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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 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 $113.90. 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:
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Drug Coverage
The Geisinger Gold Classic Advantage Rx (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard mail order, while standard retail pharmacy copays range from $2 to $5 for Tier 1 and $20 to $50 for Tier 2. Additionally, Tier 6 select care drugs are available with no copay through both standard pharmacies and standard mail order. For higher-tier medications, the plan utilizes coinsurance rather than flat copayments. Tier 3 preferred brands require a 25% coinsurance, and Tier 4 non-preferred drugs require a 37% coinsurance for both standard retail and mail order. Specialty drugs in Tier 5 are covered with a 33% coinsurance for a one-month supply at standard pharmacies and mail order.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Outpatient services, emergency care, and specialist visits are also highly affordable, generally requiring low copays and no coinsurance. This plan also includes valuable supplemental coverage, providing routine dental services and eyewear with no copay up to specified annual limits. Routine hearing and vision exams require a $20 copay, while prescription hearing aids are covered with a $500 copay. Additionally, skilled nursing facility stays offer no copay for days 1 to 20, and durable medical equipment is covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Geisinger Gold Classic Advantage Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers outpatient services with no coinsurance, featuring a $0 to $200 copay for outpatient hospital and observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse services carry no coinsurance and copays of $10 for individual sessions and $5 for group sessions.
Partial Hospitalization See details
Partial hospitalization services are covered by Geisinger Gold Classic Advantage Rx (HMO) with a $25 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers ground and air ambulance services with a $100 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 plan-approved or any 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 require 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 specialist, physical therapy, and occupational therapy visits require a $20 copay and no coinsurance. Mental health sessions have a $5 to $10 copay and no coinsurance, while chiropractic services are partially covered, with routine and other chiropractic services not covered.
Preventive Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering remote access technologies and a memory fitness benefit with no copay and no coinsurance. Non-covered services include 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/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Geisinger Gold Classic Advantage Rx (HMO) provides partial coverage for hearing services, offering routine exams and fittings for a $20 copay and no coinsurance, alongside prescription hearing aids with a $500 copay and no coinsurance up to a $1,250 maximum per ear every three years. Over-the-counter hearing aids and specific prescription aid types—including inner ear, outer ear, and over-the-ear models—are not covered.
Vision Services See details
Vision services offered by Geisinger Gold Classic Advantage Rx (HMO) are partially covered, featuring routine eye exams with a $20 copay and no coinsurance limited to one visit per year, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $200 annual limit, though upgrades are not covered.
Dental Services See details
Geisinger Gold Classic Advantage Rx (HMO) partially covers dental services, offering Medicare-covered dental with a $20 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,250 annual maximum. Covered benefits include oral exams, cleanings, x-rays, restorative care, endodontics, periodontics, removable prosthodontics, and oral surgery, but fluoride, implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental 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 have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Medical equipment is covered under the Geisinger Gold Classic Advantage Rx (HMO) with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetics, and diabetic therapeutic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to a 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic procedures and lab services have a $5 copay, outpatient X-rays and therapeutic radiological services have a $25 copay, and diagnostic radiological services have no copay.
Home Health Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, the benefit is not covered in practice as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Geisinger Gold Classic Advantage Rx (HMO) with no coinsurance and do not require a prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 to 20 and days 43 to 100, a $160 daily copay for days 21 to 42, and prior authorization is required.
Other Services See details
Other services are not covered under the Geisinger Gold Classic Advantage Rx (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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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.
* 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.
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