Geisinger Gold Classic Advantage (HMO)
Medicare Plan Details
2022 Plan
Monthly Premium
| (select county for price) |
by Geisinger Gold
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.5out of 5 stars
State: Pennsylvania
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
Medical Benefits
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 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
$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
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
20% coinsurance
5-20% coinsurance
Extra Benefits
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
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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