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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 2026, 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 2026.
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 $7100.00 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 features a $0 prescription drug deductible, meaning your coverage begins immediately with no upfront deductible costs. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard mail order for one, two, or three-month supplies. If you fill these generic prescriptions at a standard retail pharmacy, Tier 1 copays range from $2 to $5, and Tier 2 copays range from $20 to $50 depending on the supply duration. Brand-name and specialty medications under this plan are subject to coinsurance, requiring 25% coinsurance for Tier 3 preferred brands and 36% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply at both standard pharmacies and mail order. Notably, Tier 6 select care drugs are fully covered with no copay for up to a three-month supply through both standard retail and mail-order options.
Additional Benefits
The Geisinger Gold Classic 360 Rx (HMO) plan offers robust coverage for essential medical needs with predictable out-of-pocket costs and no coinsurance for many key services. You will pay no copay for primary care doctor visits, while specialist visits range from no copay to a $25 copay. For hospital stays, inpatient care requires a $175 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $115 copay that is waived if you are admitted. This plan also features valuable everyday benefits to help you manage your overall wellness, including annual physicals and preventive screenings with no copay. Dental care is covered with no copay up to a $1,000 annual limit, and routine eye exams are available for a $20 copay alongside a $300 annual eyewear allowance. Routine hearing exams are also covered with a $20 copay, though hearing aids are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is covered by Geisinger Gold Classic 360 Rx (HMO) with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Geisinger Gold Classic 360 Rx (HMO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital and observation services require a copay of $0 to $300, while outpatient substance abuse individual sessions have a $10 copay and group sessions have a $5 copay.
Partial Hospitalization See details
Geisinger Gold Classic 360 Rx (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Geisinger Gold Classic 360 Rx (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and additional transportation services to health-related locations are not covered.
Emergency Services See details
Geisinger Gold Classic 360 Rx (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $25 copay with no coinsurance, and worldwide emergency services are covered up to a $100,000 lifetime maximum with no coinsurance and copays ranging from $25 to $1,000 depending on the service.
Primary Care See details
Geisinger Gold Classic 360 Rx (HMO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $25 copay with no coinsurance. Therapy services require a $35 copay with no coinsurance, outpatient mental health and psychiatric sessions have a $5 to $10 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Geisinger Gold Classic 360 Rx (HMO) covers annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling. However, remote access technologies and memory fitness are covered, with memory fitness requiring a $10 to $25 copay and no coinsurance.
Hearing Services See details
Geisinger Gold Classic 360 Rx (HMO) partially covers hearing exams, providing one routine exam per year with a $20 copay, no coinsurance, and no deductible, while fitting and evaluation for hearing aids is not covered. For hearing aids, some services are covered, but prescription hearing aids (including all types, inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Geisinger Gold Classic 360 Rx (HMO) partially covers vision services, offering one routine eye exam per year for a $20 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay and no coinsurance up to a $300 annual limit, though upgrades are not covered.
Dental Services See details
Dental Services under Geisinger Gold Classic 360 Rx (HMO) feature covered Medicare dental services for a $25 copay and no coinsurance, as well as other covered dental services with no copay and no coinsurance up to a $1,000 annual limit. While exams, cleanings, x-rays, and restorative care are covered, this benefit is only partially covered as fluoride, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Geisinger Gold Classic 360 Rx (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, have coinsurance ranging from no coinsurance to 20%, with insulin requiring a $35 copay and other Part B drugs requiring no copay.
Dialysis Services See details
Geisinger Gold Classic 360 Rx (HMO) covers dialysis services with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Classic 360 Rx (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and prior authorization required. While most covered equipment and supplies require a 20% coinsurance, diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Classic 360 Rx (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Diagnostic services are partially covered with no copay, as diagnostic procedures, tests, and lab services are not covered, while radiological services require no copay for diagnostic radiology and a $35 copay for therapeutic and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by Geisinger Gold Classic 360 Rx (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Geisinger Gold Classic 360 Rx (HMO) covers cardiac rehabilitation services with no coinsurance and prior authorization, where some services are covered but cardiac ($25 copay), intensive cardiac ($25 copay), pulmonary ($15 copay), and SET for PAD ($20 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Geisinger Gold Classic 360 Rx (HMO) with no coinsurance and no prior three-day inpatient hospital stay required. There is no copay for days 1 through 20 and days 66 through 100, while days 21 through 65 require a $160 daily copay, with prior authorization required.
Other Services See details
Other services are partially covered by Geisinger Gold Classic 360 Rx (HMO), offering over-the-counter (OTC) items with no copay and no coinsurance up to a $50 reimbursement limit every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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