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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 2025, 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 2025.
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 $39.00. 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 $4400.00 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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you may pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you may pay a $20 copay at a standard pharmacy for preferred generic drugs, or no copay for preferred mail order for preferred generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Geisinger Gold Classic Complete Rx (HMO) plan offers a wide range of benefits, including inpatient hospital stays with a $200 copay for the first five days, and outpatient services with copays ranging from $0 to $245. The plan also covers emergency services with a $125 copay, primary care with a $20-$35 copay, and preventive services like annual physical exams. Vision and hearing services are covered with copays between $20 and $35, and dental services are covered with a $35 copay. This plan includes coverage for home health services at no cost, as well as skilled nursing facility services with a copay depending on the length of stay. There is also coverage for ambulance services, diagnostic services, and medical equipment with varying copays and coinsurance. However, certain services like routine chiropractic care, upgrades to eyewear, and many "other services" are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services with a copay between $0 and $245, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a $10 copay and group sessions with a $5 copay; however, outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Geisinger Gold Classic Complete Rx (HMO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Classic Complete Rx (HMO) plan. Ground and Air Ambulance Services each have a $200 copay, with no coinsurance. 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 Complete Rx (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a copay between $200 and $1000.
Primary Care See details
The Geisinger Gold Classic Complete Rx (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $10 copay for individual sessions and a $5 copay for group sessions, Podiatry Services with a $35 copay for routine foot care, Other Health Care Professional services with a copay between $0 and $35, 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 $35 copay, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Geisinger Gold Classic Complete Rx (HMO) plan covers preventive services including annual physical exams, glaucoma screenings, and diabetes self-management training. The plan also covers fitness benefits with a maximum plan benefit coverage amount of $90.00 every three months, and remote access technologies. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services with the Geisinger Gold Classic Complete Rx (HMO) plan include hearing exams with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered. Prescription hearing aids are covered with a $500 copay, up to $1250 every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Geisinger Gold Classic Complete Rx (HMO) plan covers vision services including eye exams and eyewear. Routine eye exams have a $20 copay, and other eye exams have a copay between $0 and $35. Eyewear has a combined maximum benefit of $100 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with no copay. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, Oral Exams (2 per year), Dental X-Rays, Prophylaxis (Cleaning) (2 per year), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery. 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, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The cost for Medicare Part B Insulin Drugs includes a $35 copay, with coinsurance between 0% and 20%. The cost for Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs includes coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Classic Complete Rx (HMO) plan, with a coinsurance between 10% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, as well as Diabetic Equipment with a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $5 copay, Lab Services with a $5 copay, Diagnostic Radiological Services with a copay between $35 and $265, Therapeutic Radiological Services with a copay between $35 and $60, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Classic Complete Rx (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and 48-100, there is no copay, while for days 21-47, the copay is $160.
Other Services See details
The "Other Services" benefit is not covered, including acupuncture, over-the-counter (OTC) 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. No authorization or referrals are required.
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