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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 generic and Tier 2 generic medications, you will pay no copay when using standard mail order, while standard pharmacy copays range from $2 to $20 for a one-month supply. Additionally, Tier 6 select care drugs are fully covered with no copay at both standard pharmacies and through standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 36% coinsurance for both retail and mail order. Specialty medications in Tier 5 are limited to a one-month supply and require a 33% coinsurance at standard pharmacies and mail order.
Additional Benefits
The Geisinger Gold Classic Complete Rx (HMO) plan offers comprehensive medical coverage featuring no deductibles and several services with no copays. Primary care visits, home health services, and annual physical exams require no copay, while specialist visits and physical therapy carry a $35 copay. Inpatient hospital stays require a $200 daily copay for days one through five followed by no copay for days six through 90, while emergency room visits carry a $130 copay. Preventive and restorative dental services are covered with no copay up to a $750 annual limit, while routine eye exams require a $20 copay. Routine hearing exams carry a $20 copay, and prescription hearing aids are partially covered with a $500 copay. Additionally, durable medical equipment and prosthetics require no copay and 20% coinsurance.
Inpatient Hospital See details
Geisinger Gold Classic Complete Rx (HMO) covers inpatient acute and psychiatric hospital stays 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 while unlimited additional acute days are covered, the plan does not cover upgrades, non-Medicare-covered stays, or additional psychiatric days.
Outpatient Services See details
Geisinger Gold Classic Complete Rx (HMO) covers outpatient services with no coinsurance, offering 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 by Geisinger Gold Classic Complete Rx (HMO) with a $55.00 copay and no coinsurance, and prior authorization is required.
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. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
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 featuring no coinsurance and no deductible, with copays waived if admitted to the hospital within 3 days. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum with no coinsurance and copays ranging from $35 to $1,000.
Primary Care See details
Geisinger Gold Classic Complete Rx (HMO) covers primary care visits with no copay and no coinsurance, while specialist, physical, and occupational therapy services require a $35 copay and no coinsurance. Mental health and psychiatric sessions feature a $5 to $10 copay with no coinsurance, opioid treatment has no copay and 20% coinsurance, and for chiropractic benefits, some services are covered, but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services under Geisinger Gold Classic Complete Rx (HMO) are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management training. While memory fitness and remote access technologies are covered, other supplemental benefits such as health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Geisinger Gold Classic Complete Rx (HMO) covers hearing exams with a $35 copay (or $20 for routine exams) 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, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Geisinger Gold Classic Complete Rx (HMO) with no deductibles. Routine eye exams require a $20 copay and no coinsurance (limited to one per year, with other eye exams not covered), while covered eyewear has no copay and no coinsurance up to a $100 annual maximum, excluding upgrades.
Dental Services See details
Geisinger Gold Classic Complete Rx (HMO) partially covers dental services, offering Medicare-covered dental with a $35 copay and no coinsurance, alongside other covered services with no copay, no coinsurance, and a $750 annual maximum. Covered services include exams, cleanings, x-rays, restorative, endodontics, periodontics, removable prosthodontics, and oral surgery, while fluoride, implants, fixed prosthodontics, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Geisinger Gold Classic Complete Rx (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Geisinger Gold Classic Complete Rx (HMO) plan with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Classic Complete Rx (HMO) covers durable medical equipment, prosthetics, and diabetic equipment with no copays and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under Geisinger Gold Classic Complete Rx (HMO) are covered with no coinsurance, though prior authorization is required. Outpatient lab services, diagnostic procedures, and tests require a $5 copay, while outpatient X-rays and therapeutic radiology require a $35 copay, and diagnostic radiology services start at no copay.
Home Health Services See details
Geisinger Gold Classic Complete Rx (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Geisinger Gold Classic Complete Rx (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Classic Complete Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 57 to 100, a $160 copay per day for days 21 to 56, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by Geisinger Gold Classic Complete Rx (HMO), which provides no coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
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