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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 $120.00. 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using standard mail order, while standard pharmacy copays range from $2 to $50 depending on the drug tier and supply length. Additionally, Tier 6 select care drugs are fully covered with no copay for both standard pharmacy and standard mail order options. Higher-tier medications under this plan require coinsurance instead of flat copayments. Tier 3 preferred brand drugs carry a 25% coinsurance, and Tier 4 non-preferred drugs require a 37% coinsurance for both standard pharmacy and standard mail order. Specialty drugs in Tier 5 are covered at a 33% coinsurance for a one-month supply.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits and routine eye and hearing exams require a low $20 copay, while inpatient hospital stays cost $150 per day for the first five days and have no copay for additional days. Emergency room visits carry a $150 copay, which is waived upon hospital admission, and urgent care visits require a $20 copay. For extra benefits, the plan features dental services and routine eyewear with no copay up to annual limits of $1,250 and $200 respectively. While diagnostic radiology and home infusion therapies are covered with no copay, dialysis and durable medical equipment require a 10% to 20% coinsurance. It is important to note that this plan does not cover over-the-counter items, meal benefits, or acupuncture.
Inpatient Hospital See details
Geisinger Gold Classic Advantage Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $150 per day for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization is required, and while additional acute days are unlimited, upgrades, non-Medicare-covered stays, and psychiatric additional 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, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services are also covered with no coinsurance and a copay of $10 for individual sessions or $5 for group sessions.
Partial Hospitalization See details
Geisinger Gold Classic Advantage Rx (HMO) covers partial hospitalization with a $25 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Geisinger Gold Classic Advantage Rx (HMO), with ground and air ambulance services requiring a $100 copay and no coinsurance, which is waived if you are admitted. Prior authorization is required for ambulance services, and while some transportation services are covered, trips to plan-approved or 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 admitted to the hospital within three days. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation 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) features primary care physician visits with no copay and no coinsurance, while specialist visits and therapy services require a $20 copay and no coinsurance. Mental health and psychiatric sessions range from a $5 to $10 copay with no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by Geisinger Gold Classic Advantage Rx (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered, offering memory fitness and remote access technologies with no copay and no coinsurance, while sub-services such as health education, in-home safety assessments, personal emergency response systems (PERS), and weight management programs are not covered.
Hearing Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers routine hearing exams and fittings for a $20 copay and no coinsurance, while prescription hearing aids are partially covered with a $500 copay and no coinsurance up to $1,250 per ear every three years. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers vision services with no deductibles or coinsurance, featuring a $20 copay for one routine eye exam per year and no copay for eyewear 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) dental services are partially covered, offering Medicare-covered dental with a $20 copay and no coinsurance, and other covered services with no copay or coinsurance up to a $1,250 annual limit. While exams, cleanings, x-rays, restorative care, endodontics, periodontics, removable prosthodontics, and oral surgery are covered, this plan does not cover fluoride, implants, fixed prosthodontics, maxillofacial prosthetics, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Geisinger Gold Classic Advantage Rx (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers dialysis services with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Classic Advantage Rx (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance, except for diabetic supplies which range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Diagnostic procedures and lab services require a $5 copay, outpatient X-rays and therapeutic radiological services carry a $25 copay, and diagnostic radiological services are offered with no copay.
Home Health Services See details
Home Health Services are covered under Geisinger Gold Classic Advantage Rx (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Geisinger Gold Classic Advantage Rx (HMO) covers some services under the Cardiac Rehabilitation Services benefit with no copay and no coinsurance, subject to prior authorization. However, 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 no prior three-day hospital stay required, although prior authorization is necessary. There is no copay for days 1–20 and days 43–100, a $160 daily copay for days 21–42, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Geisinger Gold Classic Advantage Rx (HMO) does not cover Other Services, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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