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Geisinger Gold Classic Essential Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Classic Essential 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 Essential Rx (HMO) in 2025, please refer to our full plan details page.
Geisinger Gold Classic Essential 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 Essential 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 Essential 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 Essential 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 $7550.00 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 Essential Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying costs based on the drug tier and pharmacy type. For example, you may pay a $20 copay for a Tier 1 drug at a standard pharmacy, or 10% coinsurance for a Tier 2 drug through mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan also offers a Part D premium reduction for those who qualify for the low-income subsidy, with $0 cost-sharing.
Additional Benefits
The Geisinger Gold Classic Essential Rx (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $225 copay for the first 5 days, and then no copay for the rest of the stay. Outpatient services, primary care, and home health services have some services with no copay, while others have copays ranging from $10 to $250. The plan covers emergency services, ambulance services, and skilled nursing facility stays. Diagnostic and radiological services have copays up to $235, and other services like dental, vision, and hearing have some coverage with copays. However, this plan does not cover many other services, like acupuncture, over-the-counter items, or additional home health care.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $225 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services with a copay between $0 and $250. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services are covered with a copay of $10 for individual sessions and $5 for group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Geisinger Gold Classic Essential Rx (HMO) plan and 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 Essential Rx (HMO) plan, with a $200 copay for both ground and air ambulance services. 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 Essential Rx (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a copay between $200 and $1000.
Primary Care See details
The Geisinger Gold Classic Essential Rx (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $30 copay, and mental health specialty services with a $10 copay for individual sessions and a $5 copay for group sessions. Podiatry services have a $30 copay for routine foot care, and other health care professional services have a copay between $0 and $30. Psychiatric services have a $10 copay for individual sessions and a $5 copay for group sessions. Physical therapy and speech-language pathology services have a $35 copay, additional telehealth benefits have a copay between $0 and $30, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while other services like health education, in-home safety assessments, and several others are not covered. Remote access technologies are covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $30 copay, and routine hearing exams with a $20 copay. The plan does not cover fitting/evaluation for hearing aids, prescription hearing aids, or OTC hearing aids.
Vision Services See details
Vision services with the Geisinger Gold Classic Essential Rx (HMO) plan include eye exams with a copay of $0-$30, while routine eye exams are not covered. Eyewear benefits are covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by the Geisinger Gold Classic Essential Rx (HMO) plan, with a $30 copay for Medicare Dental Services, but orthodontic services, restorative services, and other related services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Other Medicare Part B drugs, including chemotherapy/radiation drugs, have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Classic Essential Rx (HMO) plan. The coinsurance for Dialysis Services is between 10% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance, and 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 by the Geisinger Gold Classic Essential Rx (HMO) plan. Diagnostic services, including diagnostic procedures and lab services, are not covered. For diagnostic radiological services, the copay is at most $235, for therapeutic radiological services, the copay is at most $60, and for outpatient X-ray services, the copay is $30.
Home Health Services See details
Home Health Services are covered 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 technically covered, but this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Geisinger Gold Classic Essential Rx (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-68 the copay is $160, and for days 69-100, there is no copay. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Geisinger Gold Classic Essential Rx (HMO)" plan does not cover acupuncture, over-the-counter 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, or Self-Directed Personal Assistance Services.
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