Geisinger Gold Preferred Enhanced Rx (PPO) H3924-062 is a 2023 Medicare Advantage Plan or Part-C by Geisinger Gold available to residents in Pennsylvania. This plan includes extra prescription drug (Part-D) coverage. Geisinger Gold Geisinger Gold Preferred Enhanced Rx (PPO) has a monthly premium of $45.00 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be an extremely nice safety net.
Geisinger Gold works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Geisinger Gold Preferred Enhanced Rx (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Geisinger Gold and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Geisinger Gold except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Pennsylvania.
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2023 Geisinger Gold Medicare Advantage Plan Overview
What type of plan is Geisinger Gold Preferred Enhanced Rx (PPO)
Geisinger Gold Preferred Enhanced Rx (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of “preferred” providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
How much does Geisinger Gold Preferred Enhanced Rx (PPO) cost?
Monthly Premium
A monthly premium is the fee you pay to the plan in exchange for coverage. Geisinger Gold charges a $45.00 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Geisinger Gold Preferred Enhanced Rx (PPO) has a monthly drug premium of $45.00 and a $0 drug deductible. This Geisinger Gold plan offers a $45.00 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Geisinger Gold above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $45.00. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Geisinger Gold Gap Coverage
In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA “donut hole”) You will be required to pay 25% for prescription drugs unless your plan offers extra coverage. This Geisinger Gold plan does offer extra coverage through the gap.
Extra Help Premium Assistance
The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Geisinger Gold Preferred Enhanced Rx (PPO) medicare insurance offers a $3.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $14.20 for 75% low-income subsidy $24.50 for 50% and $34.70 for 25%.
MOOP
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Geisinger Gold Preferred Enhanced Rx (PPO) by Geisinger Gold MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.
Formulary and Drug Coverage
Geisinger Gold Preferred Enhanced Rx (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2023 Summary of Benefits
The benefit information provided is a summary of what Geisinger Gold Preferred Enhanced Rx (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Geisinger Gold helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
Wellness programs (e.g., fitness, nursing hotline)Covered
Contact lenses
In-Network Vision$0 copayOut-of-Network Vision$0 copay
Eyeglass frames
In-Network Vision$0 copayOut-of-Network Vision$0 copay
Eyeglass lenses
Out-of-Network Vision$0 copayIn-Network Vision$0 copay
Eyeglasses (frames and lenses)
Out-of-Network Vision$0 copayIn-Network Vision$0 copay
Other
VisionNot covered
Routine eye exam
Out-of-Network Vision$20 copayIn-Network Vision$20 copay
Upgrades
VisionNot covered TransportationNot coveredOut-of-Network 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 100In-Network 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
Occupational therapy visit
In-Network Rehabilitation services$35 copayOut-of-Network Rehabilitation services$35 copay
Physical therapy and speech and language therapy visit
Out-of-Network Rehabilitation services$35 copayIn-Network Rehabilitation services$35 copay
Cleaning
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In-Network Preventive dental$0 copayOut-of-Network Preventive dental$0 copay
Dental x-ray(s)
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In-Network Preventive dental$0 copayOut-of-Network Preventive dental$0 copay
Fluoride treatment
Preventive dentalNot covered
Oral exam
In-Network Preventive dental$0 copayOut-of-Network Preventive dental$0 copayOut-of-Network Preventive care$0 copayIn-Network Preventive care$0 copayIn-Network Outpatient hospital coverage$0-305 copay per visitOut-of-Network Outpatient hospital coverage$0-305 copay per visitIn-Network Other health plan deductibles?No Optional supplemental benefitsNo
Inpatient hospital – psychiatric
In-Network Mental health services$325 per stayOut-of-Network Mental health services$325 per stay
Outpatient group therapy visit
In-Network Mental health services$5 copayOut-of-Network Mental health services$5-10 copay
Outpatient group therapy visit with a psychiatrist
In-Network Mental health services$5 copayOut-of-Network Mental health services$5-10 copay
Outpatient individual therapy visit
In-Network Mental health services$10 copayOut-of-Network Mental health services$5-10 copay
Outpatient individual therapy visit with a psychiatrist
Out-of-Network Mental health services$5-10 copayIn-Network Mental health services$10 copay
Chemotherapy
In-Network Medicare Part B drugs20% coinsuranceOut-of-Network Medicare Part B drugs5-20% coinsurance
Other Part B drugs
In-Network Medicare Part B drugs5-20% coinsuranceOut-of-Network Medicare Part B drugs5-20% coinsurance
Diabetes supplies
Out-of-Network Medical equipment/supplies0-20% coinsurance per itemIn-Network Medical equipment/supplies0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)
Out-of-Network Medical equipment/supplies20% coinsurance per itemIn-Network Medical equipment/supplies20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)
Out-of-Network Medical equipment/supplies20% coinsurance per itemIn-Network Medical equipment/supplies20% coinsurance per item Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$7,550 In and Out-of-network$7,550 In-networkOut-of-Network Inpatient hospital coverage$325 per stayIn-Network Inpatient hospital coverage$325 per stay
Fitting/evaluation
In-Network Hearing$0 copayOut-of-Network Hearing$20 copay
Hearing aids
Out-of-Network Hearing$0 copayIn-Network Hearing$0 copay
Hearing exam
In-Network Hearing$35 copayOut-of-Network Hearing$35 copay Health plan deductible$0In-Network Ground ambulance$275 copayOut-of-Network Ground ambulance$275 copay
Foot exams and treatment
Out-of-Network Foot care (podiatry services)$35 copayIn-Network Foot care (podiatry services)$35 copay
Routine foot care
In-Network Foot care (podiatry services)$0 copayOut-of-Network Foot care (podiatry services)$0 copay
Emergency
Emergency care/Urgent care$95 copay per visit (always covered)
Urgent care
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Emergency care/Urgent care$35 copay per visit (always covered)
Primary
Out-of-Network Doctor visits$0 copayIn-Network Doctor visits$0 copay
Specialist
Out-of-Network Doctor visits$35 copay per visitIn-Network Doctor visits$35 copay per visit
Diagnostic radiology services (e.g., MRI)
In-Network Diagnostic procedures/lab services/imaging$35-235 copayOut-of-Network Diagnostic procedures/lab services/imaging$35-235 copay
Diagnostic tests and procedures
Out-of-Network Diagnostic procedures/lab services/imaging$10 copayIn-Network Diagnostic procedures/lab services/imaging$10 copay
Lab services
Out-of-Network Diagnostic procedures/lab services/imaging$10 copayIn-Network Diagnostic procedures/lab services/imaging$10 copay
Outpatient x-rays
In-Network Diagnostic procedures/lab services/imaging$35 copayOut-of-Network Diagnostic procedures/lab services/imaging$35-235 copay
Diagnostic services
Comprehensive dentalNot covered
Endodontics
Out-of-Network Comprehensive dental$0 copayIn-Network Comprehensive dental$0 copay
Extractions
In-Network Comprehensive dental$0 copayOut-of-Network Comprehensive dental$0 copay
Non-routine services
Comprehensive dentalNot covered
Periodontics
In-Network Comprehensive dental$0 copayOut-of-Network Comprehensive dental$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
In-Network Comprehensive dental$0 copayOut-of-Network Comprehensive dental$0 copay
Restorative services
Out-of-Network Comprehensive dental$0 copayIn-Network Comprehensive dental$0 copayIn-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No
Geisinger Gold Preferred Enhanced Rx (PPO) Reviews
Is Geisinger Gold Preferred Enhanced Rx (PPO) a good plan? Geisinger Gold Preferred Enhanced Rx (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Geisinger Gold Preferred Enhanced Rx Reviews among several different plans.
Staying Healthy, Screening, Testing, & Vaccines
Managing Chronic And Long Term Care for Older Adults
Member Experience with H3924-062 Health Plan
Member Complaints and Changes in Plans Performance
Health Plan Customer Service Rating for Geisinger Gold
Drug Plan Customer Service Ratings
Ratings For Member Complaints and Changes in the Drug Plans Performance
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing
Coverage Area
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Geisinger Gold Preferred Enhanced Rx (PPO) requires you to live in that plan’s service area. The service area is listed below:
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Source:CMS. Data as of Oct 1, 2022.
Last updated on
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
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