Geisinger health insurance plans are available in 42 counties of Northeastern and Central Pennsylvania and include more than 31,000 health care providers and 96 participating hospitals. You can quickly get free Marketplace quotes and the best rates on our website.
Geisinger Choice, a non-profit company, is well-known for providing affordable high-quality individual medical benefits to its customers as well as superior claims and customer service. No referrals are needed and medical advice is just a phone call away 24/7. Our easy comparison and enrollment allow you to easily apply for coverage.
Many Exchange plans are available that meet Pa Marketplace requirements. You can also qualify for the federal tax credit subsidy to help reduce the premium. Open Enrollment for 2016 effective dates runs from November 1 (2015) through January 31 (2016). However, this 3-month period could possibly expand. Also, you may be eligible for a "special enrollment period" (SEP) which allows you to purchase subsidized or non-subsidized plans at any time of the year.
The SEP is a set of exceptions that provide a 60-day window for enrollment. Some of the most common examples are divorce, newborn, reaching age 26, moving to a different area, losing your employer-based coverage and no longer eligible for Medicaid (because of income). If you're unsure about your situation, just ask us!
Many Exchange policies (depending on your income) may actually be extremely cheap or possibly free. Starting in 2014, private individual and family plans became eligible for instant federal tax credits that reduced premiums by as much as $10,000 per year. We can help you calculate your subsidy and determine which policies are eligible for the most assistance. Dental benefits are also available.
How To View Prices
We offer Geisinger individual and family medical plans at the lowest available prices. By obtaining a free quote at the top of the page, instantly, you can compare and purchase one of 27 plans. Typically, rates are very competitive when compared to other insurers. The premiums are most competitive in the Central counties of the state such as Dauphin, Lebanon, Perry, Cumberland, York, Adams, Lancaster, Berks, Lehigh and Northampton. In these counties, they seem to be able to obtain the biggest discounts for their customers.
With the passage of the Affordable Care Act (ACA), policies are divided into four categories (further discussed below). They are: Platinum, Gold, Silver and Bronze. "Catastrophic" (Value) plans are available to persons under age 30 but are not eligible for the Obamacare federal subsidy. However, prices on these contracts are the cheapest, since they cover mostly major medical and preventive expenses.
NOTE: Silver tier plans can often cost less than a Bronze or Catastrophic contract if household income meets certain Federal Poverty Level guidelines. We automatically compare all Metal tiers.
Personal PPO and group HMO options are available and are usually competitive with Highmark and UPMC. Capital Blue Cross, which is also offered through our website, also has very attractive private policies. Consumers are overwhelmingly satisfied with the "team" approach. Care seems to be better and costs are kept down.
The coordination between doctors and patients is unprecedented compared to most other carriers. Also, Highmark customers in many counties can also utilize in-network facilities since recently, a five-year contract was signed.
Free Accessories For Members
Many services and products are free (separate from the actual policy) that can reduce the cost for items you already are purchasing or using. Some of these include:
Weight Watchers - A special discount is applied for new and existing customers. Signing up takes only a few minutes. Many different types of support are available.
Healthyroads - A 10%-40% reduction in product costs is offered. You can choose among many products that you may already be using.
Glasses And Eye Exams - LensCrafters, Sears, Target, Pearle Vision and other large vendors have contracted with the carrier to receive numerous discounts related to examinations, lenses, laser vision correction and other products.
ASH Network - Receive discounts for acupuncture, massage therapy and chiropractic treatment.
Individual Geisinger Plan Options For 2016 and 2015
There are more than 25 available policies that are Affordable-Care-Act compliant and contain all of the required Obamacare mandates. We have highlighted below several of the most popular plans, based on overall cost and out-of-pocket expenses. Preventive benefits are covered in full (no deductible or waiting period) on all Metal plans. The negotiated network repricing also applies on all policies.
Only "Catastrophic" policies are not eligible for a federal subsidy. You also must be under age 30 or show proof of "financial hardship" to purchase the "Catastrophic" tier contracts. You can change to a different tier during Open Enrollment.
Marketplace Catastrophic (Value)Value - $6.500 individual deductible and $13,500 family deductibles. 0% coinsurance once the deductible is met. Tier 1 drugs do not have to meet the deductible. However, all other drugs have a 30% copay.
Marketplace Bronze Level
POS HDHP 0%/0%/6000 - $6,000 deductible with maximum $6,250 out-of-pocket expenses, and 0% coinsurance. This plan is eligible to use for HSA contracts, and any already-existing HSA funds may be used. Drug tier copays include $3 (tier 1) $20 (Tier 2), $60 (Tier 3), and $90 (Tier 4).
Extra 10/50/6000 - $6,000 deductible with 30% coinsurance and $100 additional maximum out-of-pocket expense than previous plan. However, this Bronze plan offers a very low $10 copay on primary cae physician visits when "GHP Extra" location is used. Specialist visits have a $50 copay. Most drugs are subject to a 30% coinsurance. But generic drugs, most oral contraceptives and flu/shingles vaccines are covered at 100%. Overall, this plan is the best Bronze option if you have multiple office visits. NOTE: No out-of-network coverage is included.
Marketplace Silver Level
POS 25/50/2500 - $2,500 deductible with 20% coinsurance. $25 and $50 copays on office visits. Copays on prescriptions, but deductible applies.
POS 30/50/5000 - $5,000 deductible with 30% coisurance. $30 and $50 copays on office visits. Unlike prior plan, most prescriptions are not subject to a deductible. Copays are $3 (Tier 1), $20 (Tier 2), $45 (Tier 3), and $80 (Tier 4).
PPO 30/50/5000 - Identical to previous plan, only uses a PPO (Preferred Provider Network) instead of POS (Point Of Service).
Extra 10/50/2000 - $10 copay if you you use GHP Extra. $2,000 deductible with 30% coinsurance. Deductible applied to prescriptions. However, there is no non-network coverage.
Extra 10/50/3000 - Very similar to previous plan, although deductible is $3,000. Specialist visits on both policies require a $50 copay.
Marketplace Gold Level
HMO 20/40/3000 - $20 and $40 copays (pcp and specialist) and $3,000 deductible. 20% coinsurance and copays of $3, $10, $30 and $50 on Tiers 1-4 drugs.
HMO 20/40/4000 - Similar to previous plan, but higher deductible ($4,000 instead of $3,000) and higher coinsurance (30% instead of 20%).
POS 25/50/300 - Wow! A $300 deductible policy! There aren't many of these plans available any more. Copays are $25 and $50 and the coinsurance is 20%. A deductible applies to prescriptions and $5,000 is the maximum out-of-pocket expense (per individual, capped at $10,000 per family).
POS 25/50/1000 - Similar to prior plan although deductible is higher ($1,000) and maximum out-of-pocket is $4,000). The prescription deductible is lower ($125 to $250), making this plan quite popular.
PPO 25/50/1000 - Same plan as POS 25/50/1000, only a PPO policy instead of Point-Of-Service.
POS HDHP 20%/20%/1350 - Low-deductible HSA plan with 20% coinsurance. Prescriptions, however, have a 30% coinsurance added to deductible.
Extra 10/50/500 - The "Cadillac" Geisinger Marketplace plan in the Gold tier. Low $500 deductible and $10 copay on basic office visits if you use "GHP Extra." However, higher deductibles ($250 per individual and $500 per family) apply to prescriptions.
Marketplace Platinum Level
HMO 15/30/10 - No deductible with $15/30 copays on office visits. Maximum out-of-pocket expenses are $3,000 per person and $6,000 per family. No coinsurance and deductibles are waived for most prescriptions.
Extra 10/50/0 - "GHP Extra" once again allows you to lower pcp copay to $10. Similar to HMO 15/30/10 plan although deductibles are lower ($2,000/$4,000).
A short-term plan from Geisinger can not be purchased since they were discontinued in 2013. This option was very popular since it was often used when applicants needed a stopgap policy when current benefits ended and the State Exchange had not yet begun operations. Temporary plans are not as popular now since they don't meet many of the Obamacare requirements.
However, you can keep your regular individual plan as long as you wish. Thus, if you purchased a policy with the intention of keeping it only three months, you can terminate coverage at any time. The premium, unless you get a subsidy, will likely be higher than a conventional "short-term" policy.
However, other companies offer affordable temporary policies if your need is less than 12 months, and you prefer not to enroll in a Marketplace contract. The best carriers for this type of coverage are UnitedHealthcare, IHC Group, Assurant, Companion Life And HCC Life. Prices are very cheap and when applying through our website, often you are approved in less than one day. In some instances, approval is given at the time the application is completed.
Geisinger Insurance Health Plans also feature four “High Deductible Health Plans” (HDHP) that are HSA-compatible. Options of $6,000, $4,000, $3,500 and $2,500 are available. All four policies are Point-Of-Service (POS) in the Bronze and Silver tiers. They are Marketplace Solutions 13, 12, 10 and 11 respectively.
Once the deductible is met, 90% of expenses are covered with an annual maximum out-of-pocket limit. Qualified preventive services are paid without having to meet the deductible. For expenses that are subject to a deductible, your expenses will be discounted from 10%-70% if you are treated at a Network-affiliated provider. And as previously mentioned, you won't have a problem finding a participating physician, hospital or other facility.
An HSA is a tax-sheltered savings account that allows you to pay for specified medical, dental and vision expenses with tax-favored dollars. You control the money in the account and also choose the bank that will administer the paperwork. Any unused funds can roll over to the following year. An HDHP (High Deductible Health Plan) is used in conjunction with the actual HSA side account.
I (myself, wife and two children) have had an HSA for many years and have been very satisfied with the coverage, rate and savings! The higher deductible options typically are the most cost-effective. And you can cancel your policy at any time and switch to another type of coverage. We have never met our deductible (fortunately), so we select the highest out-of-pocket costs that are offered.
An HDHP is an individual or family health insurance plan that features a high deductible. Typically, benefits are covered at 90% or 100% after the deductible has been met. Prior to the deductible, negotiated network discounts will reduce the out-of-pocket expenses. Preventive benefits are not subject to the deductible. The HDHP is issued by the insurance company and is paired with the HSA to provide low cost coverage.
How To Apply For Coverage
To compare the best options and apply for a plan, please provide your zip code in the quote request box. Then enter other requested information to view your options. If you need help, please call us at (888) 513 6446 or email us. We’ll be available to answer your questions and assist in determining which plan is best for you. We will explain details and differences of each policy and help determine which option works best for you and any other family member.
Geisinger Health Plan is an important part of the Health System. The system is a huge all-encompassing health-care Network that provides comprehensive health care and services in 40 counties of the state. It is also a non-profit, local community-based organization that utilizes physician-led health care research and various types of education. In 2012, they received JD Power and Associate's highest ranking in the state (5 points out of 5). No other insurer received a higher score!
They have received recognition from The National Committee For Quality Assurance (NCQA), which is an independent organization that measures the quality of the nation’s health care. Some of these commendations for 2010 include:
· Rated first in Pennsylvania for breast cancer and cervical cancer screenings.
· Rated Number One in the US for beta blocker treatment to members for six months following a heart attack.
· Ranked in the Top 10 in the US for appropriate follow-up within 7 and 30 days for mental illness.
· Finished in the Top 10 nationally for children who saw a doctor and had their Body Mass Index (BMI) documented and were counseled for physical activity.
Reached Age 65?
Geisinger Gold is available for persons that have reached age 65 and/or are eligible for Medicare benefits. Numerous types of Medicare Advantage policies are available including Medical Savings Accounts, PPO plans, and HMO contracts. The network contains almost 30,000 providers and 100 hospitals, so local service is always available.
"Health Navigator" is also included, which provided members free access to a case manager every hour of every day. This extra coordination of your treatment helps you save money by reducing the number of admissions to the hospital. By receiving total customized care, you'll also receive same-day treatment for Urgent-Care visits.
Medicare Supplement Plans (From least-expensive to most-expensive)
Plan F High - The cheapest option since you pay all costs until the deductible is reached.
Plan A - Hospitalization and other medical benefits (Part A and Part B). Blood and Hospice are included.
Plan B - Similar to Plan A with Part A deductible covered.
Plan M - Pays 50% of Part A deductible and also includes skilled nursing facility coinsurance and foreign travel emergency.
Plan N - Similar to Plan M but pays all of Part A deductible. Copay of up to $20 still must be paid on office visits.
Plan F - Pays Part B (and A) deductible and excess charges.
Plan C - Similar to Plan F but Part B excess charges not included.
Sample Monthly Rates for all policies are provided when you request a free quote.
September 2013 Geisinger Health Insurance Exchange plans for individuals and families are expected to be available on October 1st when Open Enrollment begins. In accordance with "The Affordable Care Act," medical questions will not be required to be answered and federal subsidies could pay a substantial portion of the premium (you must meet qualification guidelines). The new Pa Marketplace will feature all "Guarantee Issue" plans. You can view prices and apply for coverage through our website.
October 2013 Geisinger Health System Foundation has purchased Lewistown Hospital (also owned by Lewistown Foundation) despite a federal anti-trust lawsuit that was subsequently dropped. The agreement was finalized when Geisinger and the Holy Spirit System decided to try to work towards a future agreement.
The purchase stipulates that doctor and hospital service costs will remain the same through 2021 and Lewistown will remain an acute care hospital during that time.
November 2013 - Roughly 50% of the private policies in pa can be grandfathered. Since the other policies are not ACA-compliant, written notification will be sent, with options regarding obtaining new coverage. If you receive that type of correspondence, please contact us.
May 2014 - The final numbers are in for the 2014 Open Enrollment. Geisinger enrolled approximately 20,000 individuals before OE ended on March 31st. And it also appears approximately 91% of applicants have already paid their initial premium. Policies can still be purchased for persons that qualify for an SEP (Special Enrollment Period). UPDATE:
June 2014 - Atlanticare Health System will merge with Geisinger within the next 12 months. Atlanticare has most of its market share in Southern New Jersey with more than 700 doctors and specialists in its network. Both organizations are "non-profit" so there will be no cash payment involved in the purchase. New Jersey becomes the latest purchase in another state (other than Pa.), adding to recent expansions in Maine and West Virginia.
July 2014 - Highmark and Geisinger have signed a five-year agreement that allows Highmark policyholders in Eastern Pa to use facilities as "in-network." Some of the cities impacted by the continued cooperation are State College, Wilkes-Barre, Scranton and Bloomsburg. The two companies have worked together for many years and the relationship should continue beyond 2019.
Aetna also signed an agreement that allows its customers to use network facilities. The five-year contract was the first network-sharing agreement the two carriers have ever signed.
October 2014 - Viewmont Health Associates (part of PrimeMed), which has several locations in the Scranton area, has been purchased by Geisinger. PrimeMed itself and 25 facilities were earlier acquired. More than 50,000 patients are impacted although there will be no stoppage or delay in quality of service. The Scranton and Lackawanna areas are the latest areas of expansion.
PrimeMed consists of a diversified group of providers specializing in a wide array of specialties including radiology, cardiology, electrophysiology and endocrinology.
September 2015 - CleanSlate Addiction Treatment Centers will be working with Geisinger to help policyholders suffering from opiod dependence. Medication, therapy, and other related treatment will be provided through two facilities in Pennsylvania. The two locations will be in Scranton (1020 W. Lackawanna Ave.) and Wilkes-Barre (189 E. Market Street) and are expected to be ready next month.