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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 $43.00. 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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you may pay a $20 copay at a standard pharmacy for a preferred generic drug, while a standard generic drug costs 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $43.00.
Additional Benefits
The Geisinger Gold Classic Complete Rx (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $245. Emergency, primary care, hearing, vision, dental, and home health services are also covered with specific copays or coinsurance. This plan includes additional benefits such as ambulance, home infusion, and dialysis services with copays or coinsurance. It also covers medical equipment, diagnostic services, and skilled nursing facility stays with specific cost-sharing. However, it's important to note that some services like acupuncture, over-the-counter items, and certain therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. 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. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a copay between $0 and $245, Ambulatory Surgical Center (ASC) Services with no copay, and Individual and Group Sessions for Outpatient Substance Abuse with copays of $10 and $5, respectively. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Geisinger Gold Classic Complete Rx (HMO) plan, with a $55 copay, and prior authorization is required.
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 have a $200 copay, and there is no coinsurance; however, Transportation Services to plan-approved or any health-related locations 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 with no copay, 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, 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 a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers a fitness benefit, with a maximum plan benefit coverage amount of $90.00 every three months, as well as remote access technologies.
Hearing Services See details
The Geisinger Gold Classic Complete Rx (HMO) plan covers hearing exams with a $35 copay, routine hearing exams limited to one per year with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1250 every three years, with a $500 copay for all types of prescription hearing aids, but 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 include coverage for eye exams with a copay of $0-$35, and routine eye exams with a $20 copay for one visit every year. Eyewear is covered with a combined maximum benefit of $100 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $35 copay, oral exams (2 visits per year), dental x-rays, prophylaxis (cleaning) (2 visits 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Classic Complete 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 (DME) with 20% coinsurance and no copay, and prosthetic devices and medical supplies with 20% coinsurance and no copay. Diabetic equipment is covered, including diabetic supplies with between 0% and 20% coinsurance, and diabetic therapeutic shoes/inserts with 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered with a $5 copay. Diagnostic radiological services have a copay up to $265, therapeutic radiological services have a copay up to $60, and outpatient X-ray services have a $35 copay.
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. Home health services require authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Classic Complete Rx (HMO) plan, but require prior authorization. For days 1-20, there is no copay, a $160 copay for days 21-51, and no copay for days 52-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Geisinger Gold Classic Complete Rx (HMO) plan does not cover acupuncture, over-the-counter items, a meal benefit, 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, or Self-Directed Personal Assistance Services. No authorization or referral is required for these services.
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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.
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