Geisinger Gold Heritage (HMO) 2025 Plan Details for Lawrence County, Pennsylvania Residents
Geisinger Gold Heritage (HMO) 2025 Plan Details for Lawrence County, Pennsylvania Residents
Navigating your Medicare Advantage options in Lawrence County for 2025 can be overwhelming, but we're here to help. With Geisinger Gold Heritage (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Geisinger Gold Heritage Overview
Plan ID H3954-162-0 Overview | |
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Health Plan ID: | H3954-162-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $6,700 |
Part B Give Back: | $40.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | Lawrence County, PA |
Insured By: | Geisinger Gold |
Why Choose Geisinger Gold Heritage?
Geisinger Gold Heritage is a Medicare Advantage Health Maintenance Organization (HMO) plan that offers comprehensive healthcare coverage. With a monthly premium of $0.00, this plan provides all the benefits of Medicare Part A and Part B, ensuring you receive essential medical services. As an HMO plan, Geisinger Gold Heritage requires you to use healthcare providers within the plan’s network, except in emergencies, helping you manage your healthcare costs effectively.
It's important to note that Geisinger Gold Heritage does not include a Medicare prescription drug plan. If you need prescription drug coverage, you can explore standalone Part D plans. Additionally, Geisinger Gold Heritage features an annual maximum out-of-pocket (MOOP) limit of $6,700, providing financial protection by capping your healthcare expenses. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This makes Geisinger Gold Heritage a solid choice for those seeking structured and predictable healthcare coverage.
We're Here to Help You Enroll |
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Out-of-Pocket Expenses
Geisinger Gold Heritage has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H3954-162-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $20 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $20 Copay |
Routine Foot Care: | $0 Copay |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $20 Copay |
Ground ambulance: | $100 Copay |
Inpatient hospital care: | $150.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $200 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $160.00 per day for days 21 through 62 $0.00 per day for days 63 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $10 Copay |
Outpatient group therapy: | $5 Copay |
Inpatient psychiatric hospital care: | $150.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $5 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $20 Copay Prior Authorization Required |
Occupational therapy: | $20 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $150 Copay Prior Authorization Required |
Lab services: | $5 Copay Prior Authorization Required |
Outpatient x-rays: | $25 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $5 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Geisinger Gold Heritage as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Geisinger Gold offers 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: | $200.00 Every year |
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.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
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 |
Eligibility Requirements for Geisinger Gold Heritage
To enroll in Geisinger Gold Heritage, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
- Not have End-Stage Renal Disease (ESRD), with some exceptions.
If you meet these requirements, you are eligible to enroll in Geisinger Gold Heritage and benefit from its comprehensive coverage options.
Enrollment Periods for Geisinger Gold Heritage
Knowing when you can enroll in Geisinger Gold Heritage is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Sign Up for Geisinger Gold Heritage
Joining Geisinger Gold Heritage is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Geisinger Gold Heritage.
- Direct Enrollment: You can also choose to enroll directly with Geisinger Gold Heritage. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Contact Geisinger Gold
Website: | http://www.GeisingerGold.com |
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Formulary: | http://www.GeisingerGold.com |
Pharmacy: | Geisinger Gold Pharmacy Page |
New Members: | (800)514-0138 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
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.
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