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Geisinger Gold Heritage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Heritage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Geisinger Gold Heritage (HMO) in 2025, please refer to our full plan details page.
Geisinger Gold Heritage (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 Heritage (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Geisinger Gold Heritage (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 Heritage (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. Additionally, this plan comes with a Part B Premium reduction of $43.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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
Prescription drugs are not covered by Geisinger Gold Heritage (HMO).
Additional Benefits
The Geisinger Gold Heritage (HMO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays depending on the service. You'll find coverage for emergency services, primary care, and preventive services, often with no copay. The plan also includes hearing, vision, and dental benefits, along with coverage for medical equipment and home health services. This plan provides coverage for services such as ambulance, and offers a monthly allowance for over-the-counter items. However, some services like certain hearing aids, upgrades for vision and dental, and some therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the Geisinger Gold Heritage (HMO) plan. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has the same cost sharing. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services and observation services, with a copay between $0 and $200, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient Substance Abuse Services include individual and group sessions with a copay between $5 and $10, while Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Geisinger Gold Heritage (HMO) plan, but requires prior authorization. The copay for this benefit is $25.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Geisinger Gold Heritage (HMO) plan. Ground and air ambulance services have a $100 copay, and there is no coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Geisinger Gold Heritage (HMO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Transportation has a copay between $100 and $1000.
Primary Care See details
Geisinger Gold Heritage (HMO) covers Primary Care, including Primary Care Physician Services. Chiropractic Services have a $15 copay for routine care, and Occupational Therapy Services have a $20 copay. Physician Specialist Services have a $20 copay, and Mental Health Specialty Services have a $10 copay for individual sessions and a $5 copay for group sessions. Podiatry Services and Other Health Care Professional have a minimum $20 copay, while Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Geisinger Gold Heritage (HMO) plan covers preventive services including Medicare-covered services, annual physical exams, and additional preventive services with no copay. The plan also covers fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit and remote access technologies. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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.
Hearing Services See details
Hearing services include hearing exams with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a $500 copay, up to a maximum of $1250 every three years, however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Geisinger Gold Heritage (HMO) plan covers vision services, including eye exams with a copay of $0-$20 for routine eye exams. Eyewear is covered with a combined maximum of $200 per year, while contact lenses and eyeglasses (lenses and frames) are covered. Upgrades are not covered.
Dental Services See details
Dental services with the Geisinger Gold Heritage (HMO) plan include coverage for Medicare dental services with a $20 copay, oral exams (2 visits per year) with no copay, dental x-rays with no copay, prophylaxis (cleaning) (2 visits per year) with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics removable with no copay, and oral and maxillofacial surgery with no copay. 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 Insulin Drugs with a $35 copay and coinsurance between 0-20%, Medicare Part B Chemotherapy/Radiation Drugs with coinsurance between 0-20%, and Other Medicare Part B Drugs with coinsurance between 0-20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Heritage (HMO) plan. You will pay between 10% and 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Geisinger Gold Heritage (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, while Diabetic Supplies have between 0% and 20% coinsurance and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, as well as a copay for all radiological services. Diagnostic Procedures/Tests and Lab Services have a $5 copay, Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Geisinger Gold Heritage (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 technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Geisinger Gold Heritage (HMO), but require prior authorization. For days 1-20, there is no copay, for days 21-62 the copay is $160, and for days 63-100, there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
The Geisinger Gold Heritage (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $40.00 every month, including Nicotine Replacement Therapy and Naloxone; however, acupuncture, 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, and Self-Directed Personal Assistance Services are not covered.
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