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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 2026, 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 2026.
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 $70.00. 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 comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Inpatient hospital stays require a $150 copay for days one through five with no copay thereafter, while emergency care has a $130 copay. Specialist visits, physical therapy, and routine eye exams are accessible with a flat $20 copay and no coinsurance. Supplemental benefits are also a highlight of this plan, including dental coverage up to a $1,250 annual limit with no copay or coinsurance for preventive and comprehensive services. Members also benefit from a $200 annual allowance for eyewear and a $40 monthly allowance for over-the-counter items with no copay. Hearing exams are covered with a $20 copay, and over-the-counter hearing aids are available with no copay up to a $250 limit every two years.
Inpatient Hospital See details
Geisinger Gold Heritage (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Geisinger Gold Heritage (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services require a copay of $0 to $200 with no coinsurance, while outpatient substance abuse services have a $5 to $10 copay and no coinsurance.
Partial Hospitalization See details
Geisinger Gold Heritage (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Geisinger Gold Heritage (HMO) covers ground and air ambulance services with a $100 copay and no coinsurance, and this copay is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, while additional transportation services to health-related locations are not covered.
Emergency Services See details
Geisinger Gold Heritage (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 3 days. Worldwide emergency and urgent care is also covered up to a $100,000 maximum benefit with no coinsurance and copays ranging from $20 to $1,000.
Primary Care See details
Geisinger Gold Heritage (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Mental health and psychiatric sessions range from a $5 to $10 copay with no coinsurance, and opioid treatment requires a 20% coinsurance with no copay. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered under Geisinger Gold Heritage (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and select screenings. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Geisinger Gold Heritage (HMO) covers hearing services with a $20 copay and no coinsurance for exams, and no copay or coinsurance for OTC hearing aids up to $250 every two years. Prescription hearing aids are partially covered with a $500 copay and no coinsurance up to $1,250 per ear every three years, though inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Geisinger Gold Heritage (HMO) vision services are partially covered with no deductibles, offering one annual routine eye exam for a $20 copay and no coinsurance, while other eye exams are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $200 yearly limit, though upgrades are excluded.
Dental Services See details
Geisinger Gold Heritage (HMO) partially covers dental services with a $1,250 annual limit, offering no copay and no coinsurance for covered preventive and comprehensive care like exams, cleanings, and restorative work. Medicare-covered dental services require a $20 copay and no coinsurance, while specific services such as fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Geisinger Gold Heritage (HMO) with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Geisinger Gold Heritage (HMO) with no copay and a coinsurance ranging from 10% to 20%.
Medical Equipment See details
Geisinger Gold Heritage (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays, though prior authorization is required. Members will pay a 20% coinsurance for most of these medical items, with diabetic supplies ranging from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Geisinger Gold Heritage (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays have copays ranging from $5 to $25, while diagnostic radiological services are available with no copay.
Home Health Services See details
Home health services are covered by the Geisinger Gold Heritage (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Geisinger Gold Heritage (HMO) plan because all associated sub-services, including intensive cardiac and pulmonary rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Heritage (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 63 to 100, a $160 daily copay for days 21 to 62, and additional days beyond the standard 100 days are not covered.
Other Services See details
Geisinger Gold Heritage (HMO) partially covers other services, providing a monthly reimbursement of up to $40 for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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