Pennsylvania Health Insurance

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Geisinger health insurance coverage is available in 42 counties of Northeastern and Central Pennsylvania and includes more than 30,000 health care providers, 3,000 pharmacies, 220 urgent care facilities, and 120 participating hospitals. You can quickly view free Marketplace and Senior quotes with the most current rates on our website. Enrolling for coverage typically takes less than 15 minutes. A mail-in pharmacy, wellness coaching support, and pediatric dental benefits are included on all Marketplace plans. Policy choices include HMO, PPO, POS, Geisinger Extra, and QHDHP (HSA).

Founded by Abigail Geisinger more than a century ago, this carrier is a non-profit company and 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 quickly apply for coverage without paying any fees. You can also view detailed descriptions of all policies. Wellness programs are offered online, and education/support services are also available.

Pa Health Exchange

Many Exchange plans (through Pennie) are available that meet Pa Marketplace requirements. You can also qualify for the federal tax credit subsidy to help reduce the premium. Open Enrollment (Under age 65) for 2024 began November 1. This  period could possibly expand in future years, depending upon Administration changes to the Affordable Care Act. Special Enrollment Periods (SEP) are available for the remaining months. You can also apply for coverage with several other companies that do not require federal government involvement.

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 have reached age 65, you can compare many Medigap options that will help pay many out-of-pocket expenses not paid by original Medicare. 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. Earlier, 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 as stand-alone contracts or integrated with your Marketplace plan. You can select a different carrier for dental and medical benefits.

Geisinger Health Plan Service Area

Coverage is offered in the following counties:

Adams, Bedford, Berks, Blair, Bradford, Cambria, Cambria, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Elk, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Northampton, Perry, Pike, Potter, Schuylkill, Somerset, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York. Note: The “Premier” network is only available in the following counties: Carbon, Centre, Columbia, Lackawanna, Luzerne, Mifflin, Monroe, Montour, Northumberland, Schuylkill, Snyder, Union, and Wayne.

Note: The Premier Network Provides coverage in the following counties: Carbon, Centre, Columbia, Lackawanna, Luzerne, Mifflin, Monroe, Montour, Northumberland, Schuylkill, Snyder, Union, and Wayne.

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.

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 very cheap, since they cover mostly major medical and preventive expenses.Generally, up to three pcp office visits are allowed with no or small copays.

NOTE: Silver tier plans can often cost less than a Bronze or Catastrophic contract if household income meets certain Federal Poverty Level guidelines. The deductible can substantially reduce, and office visit and Urgent Care copays can also reduce. 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 utilize in-network facilities since fairly recently, a five-year contract was signed. Both Senior and under-65 plans can utilize an extensive network.

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

There are 18 available policies from Geisinger that are Affordable-Care-Act compliant and contain all of the required Obamacare mandates. We have highlighted below all Geisinger plans. 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. Because of the lack of financial aid, in many situations, Bronze or Silver options will provide significantly higher benefits, and lower out-of-pocket expenses. Note: 22 Urgent Care facilities are available that offer online reservations to avoid wait time.

Marketplace Catastrophic (Value)

Marketplace All-Access Value – $9,450 deductible with $9,450 maximum out-of-pocket expenses and 0% coinsurance. The first three pcp office visits are not subject to the deductible. Once deductible is met, covered expenses will be paid with no out-of-pocket expenses. This plan is not eligible for federal subsidies, and applicants must be under age 30. Tier 1 drugs not subject to policy deductible.

 

Marketplace Bronze Level

Marketplace All-Access HMO 40/80/8400 –  $40 and $80 office visit copays. The Urgent Care copay is also $40. Deductible is $8,400 with maximum out-of-pocket expenses of $9,100. No out-of-network benefits available. $40 Urgent Care copay.

Marketplace All-Access Premier HMO 40/80/8400 –  $40 and $80 office visit copays. The Urgent Care copay is also $40. Deductible is $8,400 with maximum out-of-pocket expenses of $9,100. No out-of-network benefits available. $40 Urgent Care copay.

Marketplace All-Access PPO 40/80/8400 –  $40 and $80 office visit copays. The Urgent Care copay is also $40. Deductible is $8,400 with maximum out-of-pocket expenses of $9,100.

Marketplace All-Access QHDHP PPO 7050 –  HSA-eligible plan. Deductible is $7,050 with maximum out-of-pocket expenses of $7,050 and 0% coinsurance.

Marketplace All-Access HMO Pharmacy First 8500 –   Deductible is $8,500 with maximum out-of-pocket expenses of $8,750. Tier 1, Tier 2, and Tier 3 drug copays are $0, $10, and $25.

 

Marketplace Silver Level

Marketplace All-Access HMO 30/60/5500 – $30 and $60 office visit copays with $30 Urgent Care copay. The ER copay is $300 (after deductible). Deductible is $5,500 with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. Tiers 1, 2, 3, 4, and 5 drug copays are $0, $3, $20, $50, and $85 ($0, $4.50, $30, $75, and $127.50 mail order). However, deductible applies to Tiers 4 and 5. Rehabilitation and habilitation services, and residential hospice services are subject to $60 copay. No out-of-network benefits are included.

Marketplace All-Access PPO 30/60/5500 – $30 and $60 office visit copays with $30 Urgent Care copay. The ER copay is $300 (after deductible). Deductible is $5,500 with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. Tiers 1, 2, 3, 4, and 5 drug copays are $0, $3, $20, $50, and $85 ($0, $4.50, $30, $75, and $127.50 mail order). However, deductible applies to Tiers 4 and 5. Rehabilitation and habilitation services, and residential hospice services are subject to $60 copay. Out-of-network services are subject to $10,000 deductible.

Marketplace Premier HMO 30/60/5500 – $30 and $60 office visit copays with $30 Urgent Care copay. The ER copay is $300 (after deductible). Deductible is $5,500 with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. Tiers 1, 2, 3, 4, and 5 drug copays are $0, $3, $20, $50, and $85 ($0, $4.50, $30, $75, and $127.50 mail order). However, deductible applies to Tiers 4 and 5. Rehabilitation and habilitation services, and residential hospice services are subject to $60 copay. No out-of-network benefits are included.

Marketplace All-Access HMO 30/60/5000  – $30 and $60 office visit copays with $30 Urgent Care copay. The ER copay is $350. Deductible is $5,000 with maximum out-of-pocket expenses of $9,000 and 30% coinsurance. Tiers 1, 2, 3, 4, and 5 drug copays are $0, $3, $20, $50, and $85 ($0, $4.50, $30, $75, and $127.50 mail order). However, deductible applies to Tiers 4 and 5. Rehabilitation and habilitation services, and residential hospice services are subject to $60 copay.

Marketplace All-Access PPO 30/50/5500  – $30 and $50 office visit copays with $30 Urgent Care copay. The ER copay is $250. Deductible is $5,500 with maximum out-of-pocket expenses of $9,000 and 30% coinsurance. Tiers 1, 2, 3, 4, and 5 drug copays are $0, $3, $20, $45, and $80 ($0, $4.50, $30, $67.50, and $120 mail order). However, deductible applies to Tiers 4 and 5. Rehabilitation and habilitation services, and residential hospice services are subject to $50 copay.

 

Marketplace Gold Level

Marketplace All-Access HMO 20/50/3250 – $20 and $50 copays (pcp and specialist). The ER copay is $350. $3,250 deductible with $8,700 maximum out-of-pocket expenses and 30% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $15, $35, and $55. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 40% coinsurance.

Marketplace All-Access PPO 20/50/3250 – $20 and $50 copays (pcp and specialist). The ER copay is $350. $3,250 deductible with $8,700 maximum out-of-pocket expenses and 30% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $15, $35, and $55. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 40% coinsurance.

Marketplace Premier HMO 20/50/3250 – $20 and $50 copays (pcp and specialist). The ER copay is $350. $3,250 deductible with $8,700 maximum out-of-pocket expenses and 30% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $15, $35, and $55. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 40% coinsurance.

Marketplace Extra HMO 10/50/500 – $50 copays (pcp and specialist). The ER copay is $300. $800 deductible with $8,700 maximum out-of-pocket expenses and 20% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $20, $45, and $80. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 50% coinsurance.

Marketplace All-Access HMO 25/45/250 – $25 and $45 copays (pcp and specialist). The ER copay is $350. $250 deductible with $7,600 maximum out-of-pocket expenses and 20% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $20, $45, and $80. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 50% coinsurance.

Marketplace All-Access HMO 25/50/2500 – $25 and $50 copays (pcp and specialist). The ER copay is $300. $2,500 deductible with $6,500 maximum out-of-pocket expenses and 20% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $20, $45, and $80. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 50% coinsurance.

Marketplace All-Access HMO 25/50/4000 – $25 and $50 copays (pcp and specialist). The ER copay is $300. $4,000 deductible with $7,450 maximum out-of-pocket expenses and 20% coinsurance. Tier 1, Tier 2, Tier 3,Tier 4, and Tier 5 drug copays are $0, $3, $20, $45, and $80. The mail order copays are $0, $4.50, $22.50, $52.50, and $82.50. Specialty drugs are subject to 50% coinsurance.

 

Marketplace Platinum Level

No plans offered.

 

Monthly Rates (Under Age-65)

35-Year-Old In Dauphin County With $33,000 Household Income

$12 – Marketplace All-Access HMO Pharmacy First 8500

$55 – Marketplace All-Access HMO 40/80/8400

$85 – Marketplace All-Access PPO 40/80/8400

$106 – Marketplace All-Access QHDHP PPO 6850

$207 – Marketplace All-Access HMO 25/50/4000

 

35-Year-Old Married Couple (2 Persons) In Dauphin County With $50,000 Household Income

$27 – Marketplace All-Access HMO Pharmacy First 8500

$111 – Marketplace All-Access HMO 40/80/8400

$172 – Marketplace All-Access PPO 40/80/8400

$213 – Marketplace All-Access QHDHP PPO 6850

$415 – Marketplace All-Access HMO 25/50/4000

 

35-Year-Old Married Couple And One Child (3 Persons) In Dauphin County With $80,000 Household Income

$246- Marketplace All-Access HMO Pharmacy First 8500

$357 – Marketplace All-Access HMO 40/80/8400

$437 – Marketplace All-Access PPO 40/80/8400

$490 – Marketplace All-Access QHDHP PPO 6850

$756 – Marketplace All-Access HMO 25/50/4000

 

45-Year-Old In Lancaster County With $31,000 Household Income

$120 – Marketplace All-Access HMO Pharmacy First 8500

$172 – Marketplace All-Access HMO 40/80/8400

$210 – Marketplace All-Access PPO 40/80/8400

$235 – Marketplace All-Access QHDHP PPO 6850

$359 – Marketplace All-Access HMO 25/50/4000

 

45-Year-Old Married Couple (2 Persons) In Lancaster County With $43,000 Household Income

$201 – Marketplace All-Access HMO Pharmacy First 8500

$305 – Marketplace All-Access HMO 40/80/8400

$380 – Marketplace All-Access PPO 40/80/8400

$431 – Marketplace All-Access QHDHP PPO 6850

$679 – Marketplace All-Access HMO 25/50/4000

 

55-Year-Old  In York County With $64,000 Household Income

$245 – Marketplace All-Access HMO Pharmacy First 8500

$327 – Marketplace All-Access HMO 40/80/8400

$384 – Marketplace All-Access PPO 40/80/8400

$423 – Marketplace All-Access QHDHP PPO 6850

$615 – Marketplace All-Access HMO 25/50/4000

 

55-Year-Old Married Couple (2 Persons) In York County With $75,000 Household Income

$116 – Marketplace All-Access HMO Pharmacy First 8500

$277 – Marketplace All-Access HMO 40/80/8400

$394 – Marketplace All-Access PPO 40/80/8400

$471 – Marketplace All-Access QHDHP PPO 6850

$855 – Marketplace All-Access HMO 25/50/4000

 

60-Year-Old  In Lebanon County With $47,000 Household Income

$10 – Marketplace All-Access HMO Pharmacy First 8500

$104 – Marketplace All-Access HMO 40/80/8400

$172 – Marketplace All-Access PPO 40/80/8400

$217 – Marketplace All-Access QHDHP PPO 6850

$441 – Marketplace All-Access HMO 25/50/4000

 

60-Year-Old Married Couple And One Child (3 Persons) In Lebanon County With $84,000 Household Income

$0 – Marketplace All-Access HMO Pharmacy First 8500

$133 – Marketplace All-Access HMO 40/80/8400

$288 – Marketplace All-Access PPO 40/80/8400

$391 – Marketplace All-Access QHDHP PPO 6850

$903 – Marketplace All-Access HMO 25/50/4000

 

Geisinger Service Areas (By County)

Main Service Area –  Adams, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Elk, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Northampton, Perry, Pike, Potter Schuylkill, Somerset, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York.

Extra Service Area – Carbon, Centre, Clinton, Columbia, Cumberland, Dauphin, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Susquehanna, Union, Wayne, and Wyoming.

Premier Service Area – Carbon, Centre, Columbia, Lackawanna, Luzerne, Mifflin, Monroe, Montour, Northumberland, Schuylkill, Snyder, Union, and Wayne.

 

Geisinger Urgent Care Locations

Aspire Urgent Care And Family Medicine – Harrisburg

Aria FastCare – Philadelphia

Aria – Jefferson – Bensalem

Concenta Urgent Care – Harrisburg, Mechanicsburg, York, Carlisle, Lancaster, and Reading

CHOP Urgent Care – Glen Mills, King Of Prussia, Bryn Mawr, and Chalfont

Commonwealth Health Priority Care – Peckville

ConvenientCare – Bellefonte, Bloomsburg, Berwick, Dallas, Lewistown, Lock Haven, Pittston, Scranton, State College, and Williamsport

DSP – East Stroudsburg

Geisinger CareWorks – Camp Hill, Carlisle, Pottsville, Burnham, Danville, Bloomsburg, Berwick, Williamsport, State College, Lock Haven, Wilkes Barre, Kingston, Pittston, Clarks Summit, Scranton, and other locations

Jefferson Urgent Care – Flourtown and Willow Grovege

Limestone Scranton Urgent Care – Scranton

MedExpress Urgent Care – Hershey, Lebanon, York, Selinsgrove, Lancaster, St. Clair, Hanover, Chambersburg, Williamsport, Exton, State College, Quakertown, and Altoona

Pocono Urgent Care – Stroudsburg and East Stroudsburg

St. Joseph Health Network – Blandon and Strausstown

St. Lukes Care Now – Hamburg, Allentown, Pennsburg, Bethlehem, Quakertown, Jim Thorpe, and Lehighton

WellSpan Urgent Care – York, Manchester, Hanover, Ephrata, Shrewsbury, Gettysburg, and Lititz

 

Temporary Coverage

A short-term Pa health plan from Geisinger can not be purchased since they were discontinued eight years ago. 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. If the OE deadline was missed, and an approved exception is not offered, short-term coverage is often the best solution.

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 receive a subsidy, will likely be higher than a conventional “short-term” policy. Any applicant with major pre-existing conditions should not consider a “temporary” plan. Typically, specialist office visits are subject to a deductible and maximum out-of-pocket expenses can be fairly high.

Several 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, and HCC Life. Prices are very cheap and when applying through our website, often you are approved in less than one day. In some situations, approval is given at the time the application is completed. Previously, Allstate (Aetna PPO Network) offered coverage, and it’s possible that may return to the Keystone State in the future. Their plans were extremely popular since they utilized the Aetna PPO Network.

 

Geisinger HSA Marketplace Plans

The only available individual or family Marketplace HSA is the All-Access QHDHP PPO 6850 plan. A QHDHP (qualified high-deductible health plan) provides lower premiums with moderately-higher deductibles.  The annual deductible is $6,850 and the maximum out-of-pocket expenses are also $6,850. Thus, the coinsurance is 0%. Other available HSAs offered in Central Pennsylvania include these Highmark plans: my Direct Blue EPO Bronze 6900 HSA, my Blue Access EPO Bronze 6900 HSA, my Direct Blue EPO Silver 3450 HSA, and my Blue Access EPO Silver 3450 HSA.

Geisinger Insurance Health Plans previously featured four “High Deductible Health Plans” (HDHP) that were HSA-compatible. Options of $6,000, $4,000, $3,500 and $2,500 were available. All four policies were Point-Of-Service (POS) in the Bronze and Silver tiers. They were Marketplace Solutions 13, 12, 10 and 11 respectively.

Once the deductible was met, 90% of expenses were covered with an annual maximum out-of-pocket limit. Qualified preventive services were 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. The side account holds the accumulated cash, which is fully accessible.

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. 2024 contribution limits for self-only HSA plans is $4,150 ($8,300 per family). The catch-up contribution continues at $1,000 for persons age 55 and over.

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 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.

About Geisinger

Geisinger Health Plan is an important part of theHealth System”. The system is a huge all-encompassing health-care network that provides comprehensive health care and services to more than 3 million persons in 45 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. Five years ago, they received JD Power and Associate’s highest ranking in the state (5 points out of 5). No other insurer received a higher score! On-demand telehealth services and ConvenientCare walk-in clinics have been recently expanding.

The company was founded more than a century ago by Abigail Geisinger for her local community. Multiple initiatives have taken place since the company formation, including “ProvenExperience,” “ProvenNavigator,” and “ProvenCare.” 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. Several previous commendations 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.

 

Senior Geisinger Medicare Plans For Persons That Have 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. The three available options are Gold Classic, Gold Preferred, and Gold Secure Rx.

“Health Navigator” is also included, which provides 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. This benefit is available to current Gold members who receive care in the Gold network.

Flu shots are offered to Seniors and consumers that have not yet reached age 65. The cost of the shots are typically free and several convenient locations are available. For the current flu season, the drive-thru locations below were utilized:

Berwick, Bloomsburg Reichart Road, Frackville, Kulpmont, Lewisburg, Milton, Orwigsburg, Pottsville, Selinsgrove, Woodbine Lane, Kingston, Scranton, Dallas, Mountain Top, Mt. Pleasant, Mt. Pocono, Pittston, Tunkhannock, Bellefonte, State College, Lewistown, Lock Haven, Lycoming, and Phillipsburg.

 

Medicare Supplement Plans (From least-expensive to most-expensive)

Plan F High And Plan G 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.

The prices provided below were for a 65 year-old applicant. However, Supplement plans are no longer offered by Geisinger.

Allegheny, Armstrong, Beaver, Butler, Fayette, Washington, and Westmoreland Counties (Male Monthly Rates)

$120 – Plan A

$151 – Plan B

$231 – Plan C

$289 – Plan F

$51 – Plan F (HD)

$150 – Plan M

$191 – Plan N

 

Allegheny, Armstrong, Beaver, Butler, Fayette, Washington, and Westmoreland Counties (Female Monthly Rates)

$118 – Plan A

$149 – Plan B

$227 – Plan C

$284 – Plan F

$50 – Plan F (HD)

$148 – Plan M

$188 – Plan N

 

Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties Counties (Male Monthly Rates)

$129 – Plan A

$157 – Plan B

$236 – Plan C

$295 – Plan F

$52 – Plan F (HD)

$156 – Plan M

$195 – Plan N

 

Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties Counties (Female Monthly Rates)

$127 – Plan A

$154 – Plan B

$232 – Plan C

$291 – Plan F

$51 – Plan F (HD)

$154 – Plan M

$192 – Plan N

 

Adams, Bedford, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Elk, Erie, Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Vernango, Warren, Wayne, Wyoming, and York Counties (Male Monthly Rates)

$110 – Plan A

$134 – Plan B

$205 – Plan C

$257 – Plan F

$46 – Plan F (HD)

$134 – Plan M

$169 – Plan N

 

Adams, Bedford, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Elk, Erie, Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Vernango, Warren, Wayne, Wyoming, and York Counties (Female Monthly Rates)

$108 – Plan A

$132 – Plan B

$202 – Plan C

$253 – Plan F

$45 – Plan F (HD)

$132 – Plan M

$166 – Plan N

Note: AARP vs. Geisinger Medicare Supplement plan comparisons are common. Both options are extremely popular Pa plans, especially in the central portion of the state.

Medicare Advantage Plans

2024 Geisinger Gold plans are offered in the following counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York.

Geisinger Gold Preferred Complete Rx (PPO) –  $0 premium with Medical Star Rating of 4.0. The deductible is $0 with maximum out-of-pocket expenses of $8,000. Office visit copays are $5 and $40, and the inpatient hospital copay is $225 for the first six days. The outpatient surgery/services copay is $0-$350. The Urgent Care and ER copays are $40 and $100, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $30 copay while the outpatient lab and outpatient x-rays copays are $30 and $40.

Outpatient MRI, PET and CET scans have a $40-$290 copay. Diagnostic hearing exams are covered with a $40 copay. The speech, physical and occupational therapy copay is $40, and the ambulance fee is $275 (waived upon submission). The podiatry copay is $40. A dental rider is available at a monthly cost of $38.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3924-065-0.

 

Geisinger Gold Classic Complete Rx (HMO) –  $34 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $4,900. Office visit copays are $0 and $35, and the inpatient hospital copay is $200 for the first five days. The outpatient surgery/services copay is $0-$245. The Urgent Care and ER copays are $35 and $120, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $5 copay while the outpatient lab and outpatient x-rays copays are $5 and $35.

Outpatient MRI, PET and CET scans have a $35-$260 copay. Diagnostic hearing exams are covered with a $35 copay. The speech, physical and occupational therapy copay is $35, and the ambulance fee is $200 (waived upon submission). The podiatry copay is $35.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3954-158-13.

 

Geisinger Gold Preferred Enhanced Rx (PPO) – $0 premium with Medical Star Rating of 4.0. The deductible is $0 with maximum out-of-pocket expenses of $7,550. Office visit copays are $0 and $35, and the inpatient hospital copay is $325. The outpatient surgery/services copay is $0-$305. The Urgent Care and ER copays are $35 and $100, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $10 copay while the outpatient lab and outpatient x-rays copays are $10 and $35.

Outpatient MRI, PET and CET scans have a $35-$235 copay. Diagnostic hearing exams are covered with a $35 copay. The speech, physical and occupational therapy copay is $5-$10, and the ambulance fee is $275 (waived upon submission). The podiatry copay is $35.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $0 (preferred generic), $5 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3924-062-23.

 

Geisinger Gold Preferred Advantage Rx (PPO) – $84 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $4,000. Office visit copays are $10 and $25, and the inpatient hospital copay is $325. The outpatient surgery/services copay is $0-$250. The Urgent Care and ER copays are $25 and $110, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $15 copay while the outpatient lab and outpatient x-rays copays are $15 and $30.

Outpatient MRI, PET and CET scans have a $30-$275 copay. Diagnostic hearing exams are covered with a $25 copay. The speech, physical and occupational therapy copay is $25, and the ambulance fee is $200 (waived upon submission). The podiatry copay is $25.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3924-059-22.

Geisinger Gold Classic Essential Rx (HMO) – $0 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $7,550. Office visit copays are $10 and $40, and the inpatient hospital copay is $325. The outpatient surgery/services copay is $0-$350. The Urgent Care and ER copays are $40 and $95, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $10 copay while the outpatient lab and outpatient x-rays copays are $10 and $35.

Outpatient MRI, PET and CET scans have a $35-$240 copay. Diagnostic hearing exams are covered with a $40 copay. The speech, physical and occupational therapy copay is $40, and the ambulance fee is $200 (waived upon submission). The podiatry copay is $40.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3954-161-0.

Geisinger Gold Classic Advantage Rx (HMO) – $144 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $3,450. Office visit copays are $0 and $20, and the inpatient hospital copay is $150 for 5 days. The outpatient surgery/services copay is $0-$200. The Urgent Care and ER copays are $20 and $125, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $5 copay while the outpatient lab and outpatient x-rays copays are $5 and $25.

Outpatient MRI, PET and CET scans have a $25-$150 copay. Diagnostic hearing exams are covered with a $20 copay. The speech, physical and occupational therapy copay is $20, and the ambulance fee is $100 (waived upon submission). The podiatry copay is $20.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3954-161-0.

Geisinger Gold Classic 360 Rx (HMO) – $0 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $7,550. Office visit copays are $0 and $35, and the inpatient hospital copay is $150 for 5 days. The outpatient surgery/services copay is $0-$300. The Urgent Care and ER copays are $35 and $95, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $0 copay while the outpatient lab and outpatient x-rays copays are $0 and $35.

Outpatient MRI, PET and CET scans have a $35-$285 copay. Diagnostic hearing exams are covered with a $35 copay. The speech, physical and occupational therapy copay is $35, and the ambulance fee is $275 (waived upon submission). The podiatry copay is $35.

Medicare Part D prescription drug benefits are included. The one-month copays at a retail preferred pharmacy are $3 (preferred generic), $20 (generic), $47 (preferred brand), $100 (non-preferred brand) and 33% (specialty). 90-day supply (mail-order) copays for Tiers 1, 2, 3, and 4 are $0, $0, $70.50, and $150. The plan number is H3954-160-0.

Geisinger Gold Heritage (HMO) – $0 premium with Medical Star Rating of 4.5. The deductible is $0 with maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $20, and the inpatient hospital copay is $150 for 5 days. The outpatient surgery/services copay is $0-$200. The Urgent Care and ER copays are $20 and $95, and are waived upon admission. Outpatient diagnostic tests and procedures are subject to a $5 copay while the outpatient lab and outpatient x-rays copays are $5 and $25.

Outpatient MRI, PET and CET scans have a $25-$150 copay. Diagnostic hearing exams are covered with a $20 copay. The speech, physical and occupational therapy copay is $20, and the ambulance fee is $100 (waived upon submission). The podiatry copay is $20.

Medicare Part D prescription drug benefits are not included.

 

Geisinger 65 Forward is included with all Gold MA plans. Health and wellness centers provide continuous support and guidance to Seniors. Current locations are Coal Township, Hazleton, Scranton, Shamokin Dam, Milton, and Wilkes-Barre. Provided personnel include social workers, nutritionists, specialized physicians, healthcare advocates, and nurses. Provided services are listed below:

Nutritional services

Lab services

Educational activities

Exercise classes

Radiology services

Wellness Coordinator

Hearing and balance services

Community support services

Pharmacy home delivery

Fitness equipment

 

Small Business Coverage Information (1-50 Employees)

Geisinger Extra – Very popular for families with children, since numerous primary physician facilities are available that feature lower copays. Also provided is a “Proven Health Navigator” website that helps workers arrange Urgent Care appointments the day you call, and health coaching. Help with transitions from medical facilities to home care are also provided. The “ProvenHealth Navigator” designation may be available, which includes same-day Urgent Care appointments, transportation from hospital to home, on-site coaching, and educational assistance with managing chronic diseases.

PPO – A large preferred provider network allows the patient to choose treatment at negotiated rates. However, out-of-network benefits are also provided.

HMO – Health Maintenance Plans require the selection of a primary care physician. Cost of coverage is often less than other options, since you must stay within the network.

POS – Point of Service plans are not as popular, but also involve the selection of a primary care physician. However, out-of-network treatment is offered at a higher out-of-pocket cost.

QHDHP – Required with HSAs (see below), premiums are lower that standard PPO and HMO plans.

HSA – Health Savings Accounts provide lower-cost healthcare coverage by using a high-deductible health plan (HDHP). Tax-free deposits into the fund are allowed. Dental and vision expenses can be paid for with qualified funds.

HRA – A plan that is employer-funded and reimburses workers for expenses not covered under a traditional plan. Distributions are tax-deductible to the employer.

Self-Funded – Your business provides the funding with the help of a large provider network.

Dental coverage is also available for small businesses. Plans are issued through Guardian Dental, who features a network with 88,000 providers and more than 200,000 locations nationwide. Benefits include full coverage for oral exams, x-rays, and cleanings.

A cost-estimator and additional online tools are included with all plan options. Other benefits include fillings, root canal, extractions, pre-existing conditions, anesthesia, routine oral exams and cleanings, extractions, fluoride treatment, and fillings.

 

Geisinger Small Business Plans

Platinum All-Access HMO 10/20/0 – $10 and $20 office visit copays with $75 ER copay. $0 deductible with $2,900 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $5, $25, and $50.

Platinum All-Access HMO 15/30/400 – $15 and $30 office visit copays with $100 ER copay. $400 deductible with $2,000 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $5, $25, and $50.

Platinum All-Access HMO 20/40/250 – $20 and $40 office visit copays with $100 ER copay. $250 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $5, $15, $30, and $60.

Platinum All-Access PPO 10/20/0 – $10 and $20 office visit copays with $75 ER copay. $0 deductible with $2,900 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $5, $25, and $50.

Platinum All-Access PPO 15/30/0 – $15 and $30 office visit copays with $200 ER copay. $0 deductible with $2,500 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $5, $25, and $50.

Platinum All-Access PPO 15/30/250 – $15 and $30 office visit copays with $100 ER copay. $250 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $5, $15, $30, and $60.

Platinum All-Access PPO 15/30/1500 – $15 and $30 office visit copays with $100 ER copay. $1,500 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $5, $15, $30, and $60.

Platinum All-Access QHDHP PPO 1500 –  $1,500 deductible with $1,500 maximum out-of-pocket expenses. HSA-eligible.

 

Gold All-Access HMO 20/40/500 – $20 and $40 office visit copays with $200 ER copay. $500 deductible with $8,150 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $5, $15, $30, and $60.

Gold All-Access HMO 20/40/1000 – $20 and $40 office visit copays with $200 ER copay. $1,000 deductible with $8,150 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $10, $20, $40, and $80.

Gold All-Access HMO 20/40/1500 – $20 and $40 office visit copays with $200 ER copay. $1,500 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $10, $20, $40, and $80.

Gold All-Access HMO 20/40/2500 – $20 and $40 office visit copays with $250 ER copay. $2,500 deductible with $8,150 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $13, $15, $40, and $60.

Silver All-Access HMO 30/60/5800 – $30 and $60 office visit copays with $350 ER copay. $5,800 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $20, $50, and $85.

Silver All-Access HMO 35/70/4300 – $35 and $70 office visit copays with $350 ER copay. $4,300 deductible with $8,150 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $20, $50, and $85.

Silver All-Access PPO 25/50/6750 – $25 and $50 office visit copays with $200 ER copay. $6,750 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $20, $45, and $80.

Silver All-Access PPO 30/60/6000 – $30 and $60 office visit copays with $250 ER copay. $6,000 deductible with $7,350 maximum out-of-pocket expenses. Tier 1, 2, 3, and 4 prescription drug copays are $3, $20, $45, and $80.

 

Family Medical Assistance Plans (Medicaid)

To qualify for coverage, all applicants must enroll in medical assistance through the Department of Human Services.  The service area consists of the following counties: Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, and Wyoming.

Benefits include unlimited prescriptions, preventative coverage, professional nursing staff, major medical, and routine office visits.

PAST UPDATES:

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.

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 and Lewistown will remain an acute care hospital during that time.

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.

The final numbers are in for 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).

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.

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.

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.

CleanSlate Addiction Treatment Centers will be working with Geisinger to help policyholders suffering from opioid 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.

Geisinger Health System has added a medical school to its network. As of January 2, Commonwealth Medical College joined the family, and continues to operate as one of the few medical schools not located in Philadelphia or Pittsburgh. Also, the Meridian Medicare Advantage plan is no longer offered. Enrollment was very low, so about 6,000 persons in Monmouth and Ocean counties (New Jersey) were able to change to a different plan.

A Geisinger nurse will participate in an Opioid Symposium hosted by the US Department of Health and Human Services. The two-day event will take place on December 6th and 7th. For the last four years, Geisinger has substantially lowered  the number of opioid prescriptions provided to patients.