Geisinger Gold Preferred Advantage Rx (PPO)

Pennsylvania Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$97
by Geisinger Gold

Additional Coverage

Hearing

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Name
Geisinger Gold Preferred Advantage Rx (PPO)
Insurance Carrier
Geisinger Gold
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

Geisinger Gold Preferred Advantage Rx (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Pennsylvania and offered by the health insurance company Geisinger Gold. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$97
Annual Deductible
$0
Max Out-of-Pocket
$4,000
Primary doctor visit
$10 copay per visit
Specialist visit
$25 copay per visit
ER visit
$140 copay per visit (always covered)
Ambulance
$200 copay

Geisinger Gold Preferred Advantage Rx (PPO) has a monthly premium cost of $97 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,000 In and Out-of-network $4,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Geisinger Gold Preferred Advantage Rx (PPO) are defined below.

Yes
Part D Prescription Drug Coverage
No
Dental
No
Vision
Yes
Hearing

Geisinger Gold Preferred Advantage Rx (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Geisinger Gold Preferred Advantage Rx (PPO) includes coverage for hearing.

Medicare Advantage health plans can offer even more additional benefits. Geisinger Gold Preferred Advantage Rx (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Geisinger Gold Preferred Advantage Rx (PPO) received an overall government quality rating of 4.5 stars out of 5 stars.

Geisinger Gold Preferred Advantage Rx (PPO) performed better than Pennsylvania’s State average overall quality score of 4.2 stars.

This Plan’s 5-star Gov’t Quality Score
Pennsylvania State Average Score
Overall Government 5 Star Quality Rating
 4.5
 4.2
Summary rating of health plan quality
 4.5
 4.2
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 4
 3.6
Member experience with health plan
 5
 4.1
Member complaints & changes in the health plan's performance
 5
 4.3
Health plan customer service
 4
 4.2
Summary rating of drug plan quality
 4.5
 4.1
Drug plan customer service
 4
 3.9
Member complaints & changes in the drug plan's performance
 4
 3.9
Member experience with the drug plan
 5
 4.4
Drug safety & accuracy of drug pricing
 4
 3.6

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Geisinger Gold Preferred Advantage Rx (PPO) received 4.5 stars for its health plan quality score which is better than the Pennsylvania State average health plan quality score of 4.2 stars.

Geisinger Gold Preferred Advantage Rx (PPO) received 4.5 stars for its drug plan quality score which is better than the Pennsylvania State average drug plan quality score of 4.1 stars.


Monthly Premium
$97
Health Portion of Premium
$30
Drug Portion of Premium
$67
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,000 In and Out-of-network
$4,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
No
Dental Coverage included
No

Doctor Services

Primary doctor visit
In-network: $10 copay per visit
Out-of-network: $10 copay per visit
Specialist visit
In-network: $25 copay per visit
Out-of-network: $25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $15 copay
Out-of-network: $15 copay
Lab services
In-network: $15 copay
Out-of-network: $15 copay
Diagnostic radiology services (like MRI)
In-network: $30-275 copay
Out-of-network: $30-275 copay
Outpatient x-rays
In-network: $30 copay
Out-of-network: $30-275 copay
Emergency care
$140 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $200 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $200 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
In-network: $0-250 copay per visit
Out-of-network: $0-250 copay per visit

Skilled nursing facility

Skilled nursing facility
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
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

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $200 copay
Out-of-network: $200 copay

Therapy services

Occupational therapy visit
In-network: $25 copay
Out-of-network: $25 copay
Physical therapy & speech & language therapy visit
In-network: $25 copay
Out-of-network: $25 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $5 copay
Out-of-network: $5 copay
Outpatient individual therapy with a psychiatrist
In-network: $10 copay
Out-of-network: $10 copay
Outpatient group therapy visit
In-network: $5 copay
Out-of-network: $5 copay
Outpatient individual therapy visit
In-network: $10 copay
Out-of-network: $10 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$3.00 copay$0 copay
Generic$20.00 copay$0 copay
Preferred Brand25% coinsurance$0 copay
Non-Preferred Drug50% coinsurance$0 copay
Specialty Tier33% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance

Hearing

Hearing exam
In-network: $25 copay
Out-of-network: $25 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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