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Geisinger Gold Value Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Geisinger Gold Value 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 Value Rx (HMO) in 2025, please refer to our full plan details page.
Geisinger Gold Value 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 Value 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 Value 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 Value Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.00. 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 $8850.00 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 Value Rx (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, you'll pay a $5 copay at a standard pharmacy for preferred generic drugs, and no copay for preferred generic drugs through mail order. For standard generic drugs, you'll pay 25% coinsurance at a standard pharmacy, and 10% coinsurance through mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Geisinger Gold Value Rx (HMO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $225 copay for days 1-5, and no copay for days 6-90. Outpatient services and primary care visits have copays ranging from $0 to $35, while emergency services and ambulance services have copays between $35 and $110. The plan includes preventive, hearing, vision, and dental benefits, with specific copays for each service. It also provides coverage for home infusion, dialysis, and medical equipment with coinsurance requirements. Additionally, the plan offers an Over-the-Counter (OTC) benefit of up to $70 per month.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services and observation services have a copay between $0 and $350, while ambulatory surgical center services have no copay. Individual sessions for outpatient substance abuse have a $10 copay, and group sessions have a $5 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Geisinger Gold Value Rx (HMO) plan. Ground and air ambulance services have a $275 copay, and there is no coinsurance. 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 Value Rx (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a copay between $275 and $1000.
Primary Care See details
The Geisinger Gold Value Rx (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a copay between $0 and $35, mental health specialty services with a $10 copay for individual sessions and a $5 copay for group sessions, podiatry services, other health care professional services with a copay between $0 and $35, psychiatric services with a $10 copay for individual sessions and a $5 copay for group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered under the Geisinger Gold Value Rx (HMO) plan, including Medicare-covered services, annual physical exams, and additional preventive services like fitness benefits, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post-discharge In-Home Medication Reconciliation, Re-admission 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 are not covered.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, and routine hearing exams with a $20 copay. Fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Geisinger Gold Value Rx (HMO) plan covers vision services, including eye exams with a copay of $0-$35. The plan also covers eyewear, including contact lenses, eyeglass lenses and frames, with a combined maximum benefit of $135 per year, but upgrades are not covered.
Dental Services See details
The Geisinger Gold Value Rx (HMO) plan covers Medicare Dental Services with a $35 copay, as well as Oral Exams (2 visits per year), Dental X-Rays, Prophylaxis (Cleaning) (2 visits per year), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery. 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $25 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Geisinger Gold Value Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered under the Geisinger Gold Value Rx (HMO) plan. Diagnostic Procedures/Tests have a copay between $10.00 and $10.00, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $240.00 (minimum $35.00), Therapeutic Radiological Services have a copay of at most $60.00 (minimum $35.00), and Outpatient X-Ray Services have a copay of $35.00.
Home Health Services See details
Home Health Services are covered under the Geisinger Gold Value Rx (HMO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Geisinger Gold Value Rx (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Geisinger Gold Value Rx (HMO) plan, but require prior authorization. You will have no copay for days 1-20 and days 65-100, and a $203 copay for days 21-64.
Other Services See details
The Geisinger Gold Value Rx (HMO) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, or a variety of other "Other Services" such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more. However, the plan does offer Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $70.00 every month, including Nicotine Replacement Therapy (NRT) and Naloxone coverage.
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