Geisinger Gold Preferred Enhanced Rx (PPO) 2024 Benefit Details for Plan H3924-062-24 by Geisinger Gold
Geisinger Gold Preferred Enhanced Rx is a 2024 PPO Medicare Advantage plan {with_without_pdp} Part D.
This Geisinger Gold option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
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Plan ID: | H3924 062 24 |
Plan Type: | Local PPO |
Plan Year: | 2024 |
Premium: | $50.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $7,550/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $0.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Geisinger Gold |
Summary of Benefits |
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Health Plan Cost Sharing
This Geisinger Gold Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $35 Copay |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $35 Copay |
Routine foot care: | $0 |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $15 Copay |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital coverage: | $325.00 per stay |
Outpatient hospital coverage: | $305 Copay Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $160.00 per day for days 21 through 68 $0.00 per day for days 69 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $10 Copay |
Outpatient group therapy visit with a psychiatrist: | $5 Copay |
Inpatient hospital - psychiatric: | $325.00 per stay |
Outpatient group therapy visit: | $5 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $35 Copay Authorization Required |
Occupational therapy visit: | $35 Copay Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $235 Copay Authorization Required |
Lab services: | $10 Copay Authorization Required |
Outpatient x-rays: | $35 Copay Authorization Required |
Diagnostic tests and procedures: | $10 Copay Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Geisinger Gold Preferred Enhanced Rx Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Geisinger Gold includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $20 Copay |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | $20 Copay |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Geisinger Gold Preferred Enhanced Rx includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $44.80 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $44.80 |
Part D Premium with Full LIS Assistance: | $4.60 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Geisinger Gold begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Geisinger Gold Preferred Enhanced Rx has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $5.00 copay |
3 (Preferred Brand) | N/A | $47.00 copay |
4 (Non-Preferred Drug) | N/A | $100.00 copay |
5 (Specialty Tier) | N/A | 33% |
6 (Vaccines ($0 cost sharing)) | N/A | $0.00 copay |
CMS Rating Marks for 2024
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this Geisinger Gold plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
This Medicare Advantage PPO plan is way better than average. Here's how we can make this claim. Geisinger Gold Preferred Enhanced Rx does an average job keeping its members healthy through preventive health measures, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions.
Overall, members say their experience with this Geisinger Gold PPO plan is excellent. When it comes to complaints and changes in performance, this plan gets the highest marks. Not the best or the worst when it comes to customer service, this health plan's customer service is average.
Geisinger Gold Preferred Enhanced Rx offers some vision and hearing benefits, but not dental.
Prospective members should carefully evaluate plan costs and benefits to understand if the plan's $50.00 dollar per month premium makes sense. Potential members should carefully factor in the maximum out-of-pocket limit of $7,550 per year. In most cases, a plan limit this high will cost members more than Original Medicare for a 5-day hospital stay. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Plan Availability
Geisinger Gold Preferred Enhanced Rx (H3924-062-24) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H3924-059-22: Geisinger Gold Preferred Advantage Rx (PPO)
- H3924-062-25: Geisinger Gold Preferred Enhanced Rx (PPO)
- H3924-062-22: Geisinger Gold Preferred Enhanced Rx (PPO)
- H3924-059-21: Geisinger Gold Preferred Advantage Rx (PPO)
- H3924-062-23: Geisinger Gold Preferred Enhanced Rx (PPO)
Contact Geisinger Gold
Plan Website: | http://www.GeisingerGold.com |
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Formulary Information: | http://www.GeisingerGold.com |
Pharmacy Information: | Geisinger Gold Pharmacy Page |
Prospective Members: | (800)514-0138 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Geisinger Gold, http://www.GeisingerGold.com, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Your Medicare coverage choices", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H3924-062-24 Plan Detail Page
The data on this Geisinger Gold Preferred Enhanced Rx plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Geisinger Gold to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Geisinger Gold, at (800)514-0138, prior to enrollment.