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Geisinger Gold Preferred Advantage Rx (PPO)

H3924 - 059 - 21
4.5 out of 5 stars (4.5 / 5)

Geisinger Gold Preferred Advantage Rx (PPO) is a Medicare Advantage Plan by Geisinger Gold.

This page features plan details for 2025 Geisinger Gold Preferred Advantage Rx (PPO) H3924 – 059 – 21 available in Pennsylvania.

Locations

Geisinger Gold Preferred Advantage Rx (PPO) is offered in the following locations.

Blair County, Pennsylvania
Bradford County, Pennsylvania
Cambria County, Pennsylvania

Click to see more locations

Plan Overview

Geisinger Gold Preferred Advantage Rx (PPO) offers the following coverage and cost-sharing.

Insurer:Geisinger Gold
Health Plan Deductible:$0
MOOP:$4,000 In and Out-of-network
$4,000 In-network
Drugs Covered:Yes

Ready to sign up for Geisinger Gold Preferred Advantage Rx (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Geisinger Gold Preferred Advantage Rx (PPO) has a monthly premium of $97.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $29.60 $67.40 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Geisinger Gold Preferred Advantage Rx (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$67.40$19.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Geisinger Gold Preferred Advantage Rx (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Diagnostic procedures/lab services/imaging

  • Lab services
    • Out-of-Network: $15 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: $15 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $30-275 copay (Authorization Required)
  • Lab services
    • In-Network: $15 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: $30-275 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $30-275 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $15 copay (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: $10 copay per visit
  • Specialist
    • Out-of-Network: $25 copay per visit
  • Primary
    • In-Network: $10 copay per visit
  • Specialist
    • In-Network: $25 copay per visit

Emergency care/Urgent care

  • Emergency
    • $140 copay per visit (always covered)
  • Urgent care
    • $25 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $25 copay
  • Routine foot care
    • In-Network: $0 copay (Limits Apply)
  • Foot exams and treatment
    • In-Network: $25 copay

Ground ambulance

    • Out-of-Network: $200 copay
    • In-Network: $200 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids – outer ear
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $25 copay
  • Fitting/evaluation
    • Not covered
  • Hearing aids – inner ear
    • Not covered
  • Hearing aids – over the ear
    • Not covered
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $25 copay

Inpatient hospital coverage

    • In-Network: $200 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: $200 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $4,000 In and Out-of-network
      $4,000 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • Out-of-Network: $5 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $10 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $200 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: $200 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $5 copay (Authorization Required)
    • Out-of-Network: $5 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $10 copay (Authorization Required)
    • Out-of-Network: $10 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $10 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $5 copay (Authorization Required)

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $0-250 copay per visit (Authorization Required)
    • In-Network: $0-250 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $25 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $25 copay (Authorization Required)
    • Out-of-Network: $25 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $25 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: $0 per day for days 1 through 20
      $160 per day for days 21 through 45
      $0 per day for days 46 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $160 per day for days 21 through 45
      $0 per day for days 46 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Other
    • Not covered
  • Contact lenses
    • Not covered
  • Eyeglass frames
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Routine eye exam
    • Not covered
  • Eyeglasses (frames and lenses)
    • Not covered
  • Upgrades
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Geisinger Gold Health+

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $38.00

Diagnostic and Preventive Dental

  • Oral Exams, Dental X-Rays, Prophylaxis (Cleaning)
    • Monthly Premium: $38.00

Eye Exams

  • Routine Eye Exams
    • Monthly Premium: $38.00

Eyewear

  • Contact Lenses, Eyeglasses (lenses and frames), Eyeglass lenses, Eyeglass frames
    • Monthly Premium: $38.00

Hearing Aids

  • Prescription Hearing Aids (all types)
    • Monthly Premium: $38.00

Hearing Exams

  • Routine Hearing Exams, Fitting/Evaluation for Hearing Aid
    • Monthly Premium: $38.00

Preventive and Other Defined Supplemental Services

  • Fitness Benefit
    • Monthly Premium: $38.00

Ready to sign up for Geisinger Gold Preferred Advantage Rx (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Geisinger Gold Preferred Advantage Rx (PPO)? See 2025 Geisinger Gold Preferred Advantage Rx (PPO) at MedicareAdvantageRX.com.

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