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Geisinger Gold Classic Complete Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Classic Complete 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 Complete Rx (HMO) in 2026, please refer to our full plan details page.
Geisinger Gold Classic Complete 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 Complete 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 Complete 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 Complete Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.00. 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 $5700.00 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 Complete 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 pharmacy copays range from $2 to $5 for Tier 1 and $20 to $50 for Tier 2 depending on the supply. Additionally, Tier 6 select care drugs have no copay for both standard pharmacy and standard mail order options. For higher-tier medications, costs are based on coinsurance rather than set copays. Tier 3 preferred brands require a 25% coinsurance, and Tier 4 non-preferred drugs require a 36% coinsurance for both standard pharmacy and mail order services. Specialty drugs in Tier 5 are available for a one-month supply at a 33% coinsurance through standard pharmacy or mail order channels.
Additional Benefits
The Geisinger Gold Classic Complete Rx (HMO) plan provides comprehensive medical coverage with clear copays and no coinsurance for many core services. Members enjoy no copay and no coinsurance for primary care doctor visits, preventive care, and home health services. Inpatient hospital stays require a $200 daily copay for days one through five and no copay for days six through 90, while specialist visits and outpatient therapy carry a $35 copay. Additional benefits include dental, vision, and hearing coverage to help lower your out-of-pocket healthcare expenses. Covered dental services feature no copay or coinsurance up to a $750 annual limit, and routine eye exams require a $20 copay with no copay for eyewear up to a $100 annual limit. Hearing exams carry a $20 to $35 copay, and durable medical equipment is covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Geisinger Gold Classic Complete Rx (HMO) with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Geisinger Gold Classic Complete Rx (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital and observation services require a copay of $0 to $245, while outpatient substance abuse services carry a $5 copay for group sessions and a $10 copay for individual sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Geisinger Gold Classic Complete Rx (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Geisinger Gold Classic Complete Rx (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Geisinger Gold Classic Complete Rx (HMO) covers emergency services with a $130 copay and urgently needed services with a $35 copay, both with no coinsurance and copays waived if admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit with no coinsurance and copays ranging from $35 to $1,000.
Primary Care See details
Geisinger Gold Classic Complete Rx (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, occupational therapy, and physical therapy visits require a $35 copay and no coinsurance. Mental health and psychiatric services carry no coinsurance with a $10 copay for individual sessions and a $5 copay for group sessions, but chiropractic services are not covered in practice.
Preventive Services See details
Geisinger Gold Classic Complete Rx (HMO) preventive services are partially covered with no copay and no coinsurance for covered care, including annual physicals, kidney disease education, and memory fitness. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, weight management programs, and nutritional/dietary benefits.
Hearing Services See details
Geisinger Gold Classic Complete Rx (HMO) covers hearing exams with a $20 to $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $500 copay and no coinsurance up to a $1,250 maximum per ear every three years, though OTC hearing aids and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Geisinger Gold Classic Complete Rx (HMO) vision services are partially covered, offering one routine eye exam per year with a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $100 annual limit, though upgrades are excluded.
Dental Services See details
Dental Services are partially covered by Geisinger Gold Classic Complete Rx (HMO), featuring Medicare-covered dental care for a $35 copay and no coinsurance, and other covered dental benefits with no copay or coinsurance up to a $750 annual limit. While services like exams, cleanings, x-rays, restorative care, endodontics, periodontics, removable prosthodontics, adjunctive general, and oral surgery are covered, the plan does not cover other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Geisinger Gold Classic Complete Rx (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Geisinger Gold Classic Complete Rx (HMO) covers Dialysis Services with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Classic Complete Rx (HMO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copays and required prior authorization. Patients will pay a 20% coinsurance for most of these items, though diabetic supplies range from no coinsurance to a 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Classic Complete Rx (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Outpatient diagnostic procedures and lab services require a $5 copay, outpatient X-rays and therapeutic radiological services require a $35 copay, and diagnostic radiological services have no copay.
Home Health Services See details
Geisinger Gold Classic Complete Rx (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Geisinger Gold Classic Complete Rx (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Classic Complete Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 to 20 and 57 to 100, a $160 copay for days 21 to 56, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Geisinger Gold Classic Complete Rx (HMO) notes that some services are covered under its other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. Members will be responsible for all costs associated with these non-covered services.
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