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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 $98.00. 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 different amounts depending on the drug tier and pharmacy. For example, in the initial coverage phase, you may pay $20 for a 30-day supply of a preferred generic drug at a standard pharmacy, or no copay at a standard mail pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Geisinger Gold Classic Advantage Rx (HMO) plan offers a variety of benefits, including inpatient and outpatient hospital care with varying copays. You'll find coverage for emergency services, primary care, preventive services, and home health services, often with low or no copays. This plan also includes coverage for hearing, vision, and dental services, with some cost-sharing and annual maximums. This plan provides additional coverage for services like ambulance, partial hospitalization, and skilled nursing facilities, with specific copays and potential prior authorization requirements. The plan also covers diagnostic and radiological services, medical equipment, and home infusion services with coinsurance or copays. However, certain services like acupuncture, over-the-counter items, and some dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Geisinger Gold Classic Advantage Rx (HMO). For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered. 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, and ambulatory surgical center services with no copay. Individual outpatient substance abuse sessions have a $10 copay, and group sessions have a $5 copay, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Geisinger Gold Classic Advantage Rx (HMO) plan, with a $25 copay. Prior authorization is required for this benefit.
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 any health-related location 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 and no coinsurance, while Worldwide Emergency Services are covered with copays ranging from $20 to $1000, depending on the service, and no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a $20 copay, Individual Sessions for Mental Health Specialty Services have a $10 copay, Group Sessions for Mental Health Specialty Services have a $5 copay, Podiatry Services have a $20 copay, Other Health Care Professional have a copay between $0 and $20, Individual Sessions for Psychiatric Services have a $10 copay, Group Sessions for Psychiatric Services have a $5 copay, Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth Benefits have a copay between $0 and $20. Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Geisinger Gold Classic Advantage Rx (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, with no copay. Additional services like Health Education, In-Home Safety Assessment, and others are not covered. The plan also covers Fitness Benefit with a maximum plan benefit coverage amount of $90.00 every three months.
Hearing Services See details
Hearing exams are covered under the Geisinger Gold Classic Advantage Rx (HMO) plan with a $20 copay, while prescription hearing aids are covered with a $500 copay, and a maximum plan benefit of $1250 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan, including eye exams with a copay of $0-$20 and eyewear with a combined maximum benefit of $200 every year. The plan covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, Other Dental Services with a $1,250 annual maximum, Oral Exams with a $20 copay for 2 visits per year, Dental X-Rays, Prophylaxis (Cleaning) with a $20 copay for 2 visits per year, and Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery. This plan does not cover Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is 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 by the Geisinger Gold Classic Advantage Rx (HMO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment 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, and medical supplies have a 20% coinsurance. Diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Geisinger Gold Classic Advantage Rx (HMO) plan. Diagnostic Procedures/Tests and Lab Services have 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-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 additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services (Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are covered. Prior authorization is required.
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.
Other Services See details
The Geisinger Gold Classic Advantage Rx (HMO) plan does not cover acupuncture, over-the-counter items, meal benefits, 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. This plan does not require authorization or referrals for these services.
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