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Geisinger Gold Classic 360 Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Classic 360 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 360 Rx (HMO) in 2025, please refer to our full plan details page.
Geisinger Gold Classic 360 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 360 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 360 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 360 Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $8000.00 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 360 Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you may have no copay for preferred generic drugs through mail order, or pay a 25% coinsurance for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Geisinger Gold Classic 360 Rx (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll have no copay for primary care visits, along with coverage for preventive services, vision, and dental care. The plan also covers ambulance and emergency services, home health, and skilled nursing facilities with specific copays and coinsurance amounts. Additional benefits of this plan include coverage for hearing exams, diagnostic and radiological services, and medical equipment. The plan also offers over-the-counter (OTC) items and services like nicotine replacement therapy. However, some services, such as routine chiropractic care, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $150 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, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services and observation services with a copay between $0 and $300, and Ambulatory Surgical Center (ASC) Services with no copay. Individual and group sessions for outpatient substance abuse are covered with a copay of $10 and $5, respectively, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Geisinger Gold Classic 360 Rx (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Classic 360 Rx (HMO) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage, there is a $110 copay, and for Urgently Needed Services, the copay is $25. Worldwide Emergency Transportation has a copay between $275 and $1000, and Worldwide Urgent Coverage has a $25 copay. There is no coinsurance for any of these services.
Primary Care See details
The Geisinger Gold Classic 360 Rx (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $25 copay, mental health specialty services with a copay of $10 for individual sessions and $5 for group sessions, podiatry services with a $25 copay for routine foot care (up to 4 visits per year), other health care professional services with a copay between $0 and $25, psychiatric services with a copay of $10 for individual sessions and $5 for group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services, including fitness benefits, with a copay of $10-$25. Other preventive services, such as Health Education, and services like Personal Emergency Response Systems, are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a $20 copay, but fitting/evaluation for hearing aids and prescription hearing aids are not covered. Over-the-counter hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$25, and eyewear with a combined maximum benefit of $100 per year. Routine eye exams have a $20 copay for one visit per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The Geisinger Gold Classic 360 Rx (HMO) plan covers Medicare Dental Services with a $25 copay and other dental services up to a $1500 annual maximum. This plan covers oral exams (2 per year), dental x-rays, and prophylaxis (cleaning) (2 per year). However, 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 Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%. The plan also covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Geisinger Gold Classic 360 Rx (HMO). You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Geisinger Gold Classic 360 Rx (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices have a coinsurance of 20%, while Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Geisinger Gold Classic 360 Rx (HMO) plan. Diagnostic services, including procedures/tests and lab services, are not covered; however, Diagnostic Radiological Services have a copay of at most $275, Therapeutic Radiological Services have a copay of at most $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 360 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 covered by the Geisinger Gold Classic 360 Rx (HMO) plan, but none of the sub-services are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Classic 360 Rx (HMO) plan, but require prior authorization. You will have no copay for days 1-20, a $160 copay for days 21-70, and no copay for days 71-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Other Services" benefit covers over-the-counter (OTC) items with a maximum benefit coverage amount of $35.00 per month, and includes nicotine replacement therapy and Naloxone coverage. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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