Geisinger Gold Classic Essential Rx (HMO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by Geisinger Gold
Additional Coverage
Hearing
Overall Government Star Rating
4.0out of 5 stars
State: Pennsylvania
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
Medical Benefits
Doctor Services
$10 copay per visit
$40 copay per visit
Tests, labs, & imaging
$10 copay
$10 copay
$35-255 copay
$35 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)
Hospital Services
$225 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 6 through 90
$0-350 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$160 per day for days 21 through 68
$0 per day for days 69 through 100
$160 per day for days 21 through 68
$0 per day for days 69 through 100
Preventive services
$0 copay
Ambulance
$200 copay
Therapy services
$40 copay
$40 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
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $3.00 copay | $3.00 copay |
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | |||
| Specialty Tier | 33% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
$40 copay
Not covered
Not covered
Not covered
Not covered
Preventive Dental
Not covered
Not covered
Not covered
Not covered
Comprehensive dental
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Vision
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Other benefits
Not covered
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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