Geisinger Gold Secure Rx (D-SNP) Plan Details for Sullivan County, PA
This Geisinger Gold plan has an overall rating of 4.0 (Good) out of 5 stars.
Geisinger Gold Secure Rx (D-SNP HMO) is a Medicare Advantage Special Needs Plan. Enroll for 2025 starting Oct 15. Get notified.
Delivery of healthcare services and costs by Geisinger Gold differs from Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all qualification requirements can join this Geisinger Gold D-SNP plan.
2025 Geisinger Gold Secure Rx Cost and Coverage Notification
The 2025 cost and coverage information for Geisinger Gold Secure Rx will not be available until early October. We'll notify you when it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 enrollment period begins October 15.
| Plan Basics | |
|---|---|
| Plan ID: | H3954-097-0 |
| Plan Type: | HMO |
| Plan Year: | 2024 |
| Premium: | $40.20/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Basic $545.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Sullivan County, PA |
| Insured By: | Geisinger Gold |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
Geisinger Gold Secure Rx is a Health Maintenance Organization (HMO) plan. HMO D-SNP plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Geisinger Gold Secure Rx does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Geisinger Gold plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | 0% Coinsurance |
| Specialist: | 0% Coinsurance |
| Wellness programs (e.g., fitness, nursing hotline): | |
| Preventive care: | 0% Coinsurance |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | 0% Coinsurance |
| Routine foot care: | 0% Coinsurance |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | 0% Coinsurance |
| Routine chiropractic care: | 0% Coinsurance |
| Emergency Care / Urgent Care | |
| Emergency room care: | 0% Coinsurance |
| Urgent care: | 0% Coinsurance |
| Ground ambulance: | 0% Coinsurance |
| Inpatient hospital coverage: | |
| Outpatient hospital coverage: | 0% Coinsurance Prior Authorization Required |
| Skilled Nursing Facility: | |
| Optional supplemental benefits: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | 0% Coinsurance |
| Outpatient group therapy visit with a psychiatrist: | 0% Coinsurance |
| Inpatient hospital - psychiatric: | |
| Outpatient group therapy visit: | 0% Coinsurance |
| Outpatient individual therapy visit: | 0% Coinsurance Prior Authorization Required |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | 0% Coinsurance Prior Authorization Required |
| Occupational therapy visit: | 0% Coinsurance Prior Authorization Required |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | 0% Coinsurance Prior Authorization Required |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 0% Coinsurance Prior Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 0% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | 0% Coinsurance Prior Authorization Required |
| Lab services: | 0% Coinsurance Prior Authorization Required |
| Outpatient x-rays: | 0% Coinsurance Prior Authorization Required |
| Diagnostic tests and procedures: | 0% Coinsurance Prior Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 0% Coinsurance |
| Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Feel free to download our Geisinger Gold Secure Rx Summary of Benefits information.
Supplemental Health Plan Benefits (H3954-097-0)
The following is a summary of the supplemental benefits Geisinger Gold includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| 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 | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | Covered Limits may apply |
| Vision | Maximum vision benefit: | $425.00 Every year |
| Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
| Routine eye exam (In-Network) | Covered Limits may apply |
| Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Geisinger Gold Secure Rx includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
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. The following table outlines the details of this plan's prescription drug plan premium.
| Basic Part D Premium: | $40.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $40.20 |
| Part D Premium with Full LIS Assistance: | $0.00 |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. 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 Secure Rx has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
CMS Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Geisinger Gold plan.
| CMS Measure | Star Rating |
|---|---|
| 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 |
How to Qualify to Enroll in
Geisinger Gold Secure Rx
To qualify for enrollment in Geisinger Gold Secure Rx in Sullivan County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Pennsylvania's state thresholds.
Before enrolling in Geisinger Gold Secure Rx, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- None.
Contact Geisinger Gold
| Plan Website: | http://www.GeisingerGold.com |
|---|---|
| Formulay 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.
Health Plan Compatibility
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold Medicare Supplement Insurance at the same time.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Geisinger Gold, http://www.GeisingerGold.com, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Pennsylvania", Last Accessed January 4, 2024
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.