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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 2026, 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 2026.
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 $9250.00 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 offers a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket costs. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs through standard pharmacies and standard mail order. Additionally, Tier 2 generic medications have no copay when ordered through standard mail order, or a low $5 copay for a one-month supply at standard pharmacies. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance at standard pharmacies and mail order. Tier 5 specialty drugs are covered with a 33% coinsurance for a one-month supply.
Additional Benefits
The Geisinger Gold Value Rx (HMO) plan offers affordable access to essential medical services, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialist visits, routine eye exams, and urgent care, you will pay a low copay of up to $35 with no coinsurance. Inpatient hospital stays require a copay of $225 per day for the first six days, while emergency room visits carry a $115 copay, both with no coinsurance. This plan also includes key supplemental benefits, such as routine dental cleanings and exams with no copay up to a $100 annual limit. Eyewear is covered with no copay up to a $135 annual maximum, and members receive a $70 monthly reimbursement for over-the-counter items with no copay. For durable medical equipment and dialysis, you will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Geisinger Gold Value Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $225 per day for days 1 through 6, followed by no copay for days 7 through 90. Unlimited additional days are covered for acute stays, but psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Geisinger Gold Value Rx (HMO) outpatient services are covered with no coinsurance, including ambulatory surgical center and blood services which feature no copay. Outpatient hospital and observation services carry a copay of $0 to $350, while outpatient substance abuse individual sessions have a $10 copay and group sessions have a $5 copay.
Partial Hospitalization See details
Geisinger Gold Value Rx (HMO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Geisinger Gold Value Rx (HMO) with a $275 copay and no coinsurance for ground and air ambulance transportation, and this copay is waived if you are admitted to the hospital. For routine transportation, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Geisinger Gold Value Rx (HMO) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both with no coinsurance and copays waived if admitted to the hospital within 3 days. Worldwide emergency services are also covered up to a $100,000 maximum with no coinsurance, requiring copays of $115 for emergency care, $35 for urgent care, and $275 to $1,000 for emergency transportation.
Primary Care See details
Geisinger Gold Value Rx (HMO) offers primary care and podiatry visits with no copay and no coinsurance, while specialist visits, telehealth, and physical, occupational, and speech therapies carry copays up to $35 with no coinsurance. Mental health and psychiatric sessions have a $5 to $10 copay with no coinsurance, opioid treatment has a 20% coinsurance with no copay, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are covered by Geisinger Gold Value Rx (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings like glaucoma and diabetes self-management. Additional preventive services are only partially covered, as fitness and remote access benefits are included, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy 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 are not covered.
Hearing Services See details
Hearing services are partially covered by Geisinger Gold Value Rx (HMO), offering routine hearing exams for a $20 copay and diagnostic exams for a $35 copay, both with no coinsurance. Fitting and evaluation for hearing aids, OTC hearing aids, and all types of prescription hearing aids are not covered under this plan.
Vision Services See details
Geisinger Gold Value Rx (HMO) partially covers vision services with no deductibles, offering one annual routine eye exam for a $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $135 annual maximum for frames, lenses, or contacts, but upgrades are not covered.
Dental Services See details
Geisinger Gold Value Rx (HMO) provides partially covered dental services, featuring Medicare-covered dental care for a $35 copay and no coinsurance, and other covered services like cleanings, exams, and restorative care with no copay and no coinsurance up to a $100 annual maximum. Specific services such as fluoride, implants, orthodontics, fixed prosthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Geisinger Gold Value Rx (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin has a $25 copay and 0% to 20% coinsurance.
Dialysis Services See details
Geisinger Gold Value Rx (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Geisinger Gold Value Rx (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, and medical supplies incur a 20% coinsurance, and diabetic supplies carry a 0% to 20% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Geisinger Gold Value Rx (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services and diagnostic radiological services, while diagnostic procedures and tests require a $10 copay, outpatient X-rays cost $35, and therapeutic radiological services have a minimum $35 copay.
Home Health Services See details
Geisinger Gold Value Rx (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Geisinger Gold Value Rx (HMO) with no coinsurance and require prior authorization. In practice, only some services are covered, while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Geisinger Gold Value Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 to 20 and days 67 to 100, a $203 daily copay for days 21 to 66, and additional days beyond the Medicare limit are not covered.
Other Services See details
Geisinger Gold Value Rx (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $70 monthly reimbursement limit. Acupuncture, meal benefits, and certain drugs on the CMS OTC list are not covered under this plan.
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