4

4 out of 5 stars* for plan year 2024

Plan ID: H3954-156

What You Need to Know:

  • Geisinger Gold Classic Advantage (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO * plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $30, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $3,450 per year (in-network).
  • Geisinger Gold Classic Advantage (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$30

Monthly Premium

Medicare Plan Features
Monthly Premium: $30.00
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$30.00 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Local HMO *
Similar Plan: H3954-157
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,450
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in Clearfield, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
115 members 4 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in Clearfield, Pennsylvania: 1,965 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
NULL NULL NULL NULL
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
NULL NULL NULL NULL NULL NULL NULL
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

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5
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Geisinger Gold Classic 360 Rx (HMO) (2023)Local HMO$7,550$0
4
Aetna Medicare Advantra Silver (HMO) (2023)Local HMO$7,550$0
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4
Security Blue HMO-POS ValueRx (HMO-POS) (2023)Local HMO$5,500$0
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Geisinger Gold Classic Advantage Rx (HMO) (2023)Local HMO$3,450$0
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Geisinger Gold Preferred Advantage Rx (PPO) (2023)Local PPO$4,000$0
3
Geisinger Gold Classic Complete Rx (HMO) (2023)Local HMO$4,900$0
4
Freedom Blue PPO Classic (PPO) (2023)Local PPO$4,500$0
4
Security Blue HMO-POS Standard (HMO-POS) (2023)Local HMO$5,000$0
4
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$0
4
Complete Blue PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
Security Blue HMO-POS Deluxe (HMO-POS) (2023)Local HMO$4,500$0
4
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Preferred Complete Rx (PPO) (2023)Local PPO$6,700$0
3
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
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3
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4
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5
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
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4
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4
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
4
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4
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4
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4
Medicare Advantage Plans by Geisinger Gold
Geisinger Gold Classic Essential Rx (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Classic 360 Rx (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Classic Advantage Rx (HMO) (2023)Local HMO$3,450$0
4
Geisinger Gold Preferred Advantage Rx (PPO) (2023)Local PPO$4,000$0
3
Geisinger Gold Classic Complete Rx (HMO) (2023)Local HMO$4,900$0
4
Geisinger Gold Preferred Complete Rx (PPO) (2023)Local PPO$6,700$0
3
Geisinger Gold Preferred Enhanced Rx (PPO) (2023)Local PPO$6,700$0
3

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