Geisinger Gold Classic Advantage (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Geisinger Gold
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.5
out of 5 stars

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Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$0
$3,450 In-network
No
Yes
Yes
Yes

Doctor Services

$0 copay
$20 copay per visit

Tests, labs, & imaging

$5 copay
$5 copay
$25-150 copay
$25 copay
$120 copay per visit (always covered)
$20 copay per visit (always covered)

Hospital Services

$150 per day for days 1 through 5
$0 per day for days 6 through 90
$0-200 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$160 per day for days 21 through 42
$0 per day for days 43 through 100

Preventive services

$0 copay

Ambulance

$100 copay

Therapy services

$20 copay
$20 copay

Mental health services

$5 copay
$10 copay
$5 copay
$10 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
0-20% coinsurance per item

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

Part B Drugs

20% coinsurance
5-20% coinsurance

Hearing

$20 copay
$0 copay
$500 copay

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
Not covered
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Vision

$20 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 4.5
 3
 4
 5
 5
 5

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