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Geisinger Gold Medicare benefit documents
2026 benefit documents
Download your 2026 benefit documents. (All files are PDFs.)
2026
2026 Summaries of Benefits documents:
Geisinger Gold Preferred Advantage Rx (PPO) (updated 08/26/2025) – Servicing Counties: Blair, Bradford, Cambria, Cameron, Centre, Clearfield, Clinton, Columbia, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming
Geisinger Gold Preferred Advantage Rx (PPO) (updated 08/26/2025) – Servicing Counties: Adams, Berks, Bucks, Carbon, Chester, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Lehigh, Monroe, Northampton, Perry, York
Geisinger Gold Preferred Complete Rx (PPO) (updated 08/26/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Secure Rx (HMO D-SNP) (updated 08/26/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Classic Advantage Rx (HMO) (updated 08/26/2025) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic Advantage Rx (HMO) (updated 08/26/2025) – Servicing Counties: Bucks, Carbon, Centre, Clinton, Juniata, Lackawanna, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wayne, Wyoming
Geisinger Gold Classic Advantage Rx (HMO) (updated 08/26/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Cambria, Cameron, Chester, Clearfield, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Lancaster, Lebanon, Perry, Potter, Somerset, Tioga, York
Geisinger Gold Classic Complete Rx (HMO) (updated 08/26/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, Clearfield, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Potter, Somerset, Sullivan, Susquehanna, Tioga, Wayne, Wyoming, York
Geisinger Gold Classic Complete Rx (HMO) (updated 08/26/2025) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic 360 Rx (HMO) (updated 08/26/2025) – Servicing Counties: Blair, Bucks, Cambria, Centre, Clearfield, Clinton, Huntingdon, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wyoming
Geisinger Gold Classic Essential Rx (HMO) (updated 08/26/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Heritage (HMO) (updated 08/26/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Value Rx (HMO) (updated 08/26/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Enrollment Forms (2026)
Annual Notice of Changes (ANOC) (2026)
If you are a current Geisinger Gold member and will remain enrolled for 2026, view your 2026 Annual Notice of Changes (ANOC) below:
Geisinger Gold Preferred Advantage Rx (PPO) (updated 09/16/2025) – Servicing Counties: Blair, Bradford, Cambria, Cameron, Centre, Clearfield, Clinton, Columbia, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming
Geisinger Gold Preferred Advantage Rx (PPO) (updated 09/16/2025) – Servicing Counties: Adams, Berks, Bucks, Carbon, Chester, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Lehigh, Monroe, Northampton, Perry, York
Geisinger Gold Preferred Complete Rx (PPO) (updated 09/16/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Secure Rx (HMO D-SNP) (updated 09/16/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Classic Advantage Rx (HMO) (updated 09/16/2025) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic Advantage Rx (HMO) (updated 09/16/2025) – Servicing Counties: Bucks, Carbon, Centre, Clinton, Juniata, Lackawanna, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wayne, Wyoming
Geisinger Gold Classic Advantage Rx (HMO) (updated 09/16/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Cambria, Cameron, Chester, Clearfield, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Lancaster, Lebanon, Perry, Potter, Somerset, Tioga, York
Geisinger Gold Classic Complete Rx (HMO) (updated 09/16/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, Clearfield, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Potter, Somerset, Sullivan, Susquehanna, Tioga, Wayne, Wyoming, York
Geisinger Gold Classic Complete Rx (HMO) (updated 09/16/2025) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic 360 Rx (HMO) (updated 09/16/2025) – Servicing Counties: Blair, Bucks, Cambria, Centre, Clearfield, Clinton, Huntingdon, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wyoming
Geisinger Gold Classic Essential Rx (HMO) (updated 09/16/2025) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Heritage (HMO) (updated 09/16/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Value Rx (HMO) (updated 09/16/2025) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Evidence of Coverage (2026)
If you are a current Geisinger Gold member and will remain enrolled for 2026, view your 2026 Evidence of Coverage documents below:
Geisinger Gold Preferred Advantage Rx (PPO) – Servicing Counties: Blair, Bradford, Cambria, Cameron, Centre, Clearfield, Clinton, Columbia, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Union, Tioga, Wayne, Wyoming
Geisinger Gold Preferred Advantage Rx (PPO) – Servicing Counties: Adams, Berks, Bucks, Carbon, Chester, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Lehigh, Monroe, Northampton, Perry, York
Geisinger Gold Preferred Complete Rx (PPO) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Secure Rx (HMO D-SNP) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Classic Advantage Rx (HMO) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic Advantage Rx (HMO) – Servicing Counties: Bucks, Carbon, Centre, Clinton, Juniata, Lackawanna, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wayne, Wyoming
Geisinger Gold Classic Advantage Rx (HMO) – Servicing Counties: Adams, Berks, Blair, Bradford, Cambria, Cameron, Chester, Clearfield, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Lancaster, Lebanon, Perry, Potter, Somerset, Tioga, York
Geisinger Gold Classic Complete Rx (HMO) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, Clearfield, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Potter, Somerset, Sullivan, Susquehanna, Tioga, Wayne, Wyoming, York
Geisinger Gold Classic Complete Rx (HMO) – Servicing Counties: Columbia, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union
Geisinger Gold Classic 360 Rx (HMO) – Servicing Counties: Blair, Bucks, Cambria, Centre, Clearfield, Clinton, Huntingdon, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Northampton, Pike, Sullivan, Susquehanna, Wyoming
Geisinger Gold Classic Essential Rx (HMO) – Servicing Counties: Adams, Berks, Blair, Bradford, Bucks, Cambria, Cameron, Carbon, Centre, Chester, 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, York
Geisinger Gold Heritage (HMO) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Geisinger Gold Value Rx (HMO) – Servicing Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Cumberland, Dauphin, Delaware, Elk, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mifflin, Monroe, Montgomery, Montour, Northampton, Northumberland, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Plan Star Ratings from Centers for Medicare and Medicaid Services (CMS)
- Plan Contract H3954 (includes Geisinger Gold HMO and D-SNP plans) (updated 10/15/2025)
- Plan Contract H3924 (includes Geisinger Gold PPO plans) (updated 10/15/2025)
Updates and information
Member newsletter updates
Geisinger Gold Member update – Quarter 1 2026
Geisinger Gold Member update – Quarter 4 2025
Geisinger Gold Member update – Quarter 3 2025
Geisinger Gold Member update – Quarter 2 2025
Geisinger Gold Secure Rx Member update - Quarter 1 2026
Geisinger Gold Secure Rx Member update - Quarter 4 2025
Geisinger Gold Secure Rx Member update - Quarter 3 2025
Geisinger Gold Secure Rx Member update - Quarter 2 2025
Things you should know
Quality information
Geisinger Gold is committed to providing quality healthcare to our members. One way we can ensure that we are holding ourselves to the highest standards is to review our performance against accepted care and service measures. For example, the Healthcare Effectiveness Data and Information Set (HEDIS®)* provides a set of measures against which we can judge our effectiveness.
Quality indicators, such as HEDIS and other initiatives, are set forth by the National Committee for Quality Assurance (NCQA) to ensure that Gold members receive high quality care.
Geisinger Gold conducts an aggressive preventive health program, geared toward members most at risk for a variety of preventable illnesses, ailments and diseases.
Health Equity Report
Below is the latest prior authorization report on Geisinger Health Plan’s Medicare Advantage plans.
We all share the same goal—making sure you and your loved ones get the care they deserve. That’s why reporting on health equity matters. The data below lets you see how Geisinger is reviewing and responding to prior authorizations. It is a healthcare practice we believe in and trust to help our members get the right care at the right time from the right doctor in the right place.
Approval and denial rates by population
| Group | Standard approval | Standard denial | Expedited approval | Expedited denial |
| All in Medicare | 97.97% | 2.03% | 96.14% | 3.86% |
| Gold HMO | 97.71% | 2.29% | 95.72% | 4.28% |
| Gold PPO | 98.38% | 1.62% | 96.62% | 3.38% |
| DSNP Population | 96.95% | 3.05% | 91.01% | 8.99% |
| CMS Disability Flag population | 97.43% | 2.57% | 95.62% | 4.38% |
Hours to decision by population
| Group | Standard average | Standard median | Expedited average | Expedited median |
| All in Medicare | 13.87 | 0.00 | 7.12 | 1.00 |
| Gold HMO | 12.98 | 0.00 | 6.50 | 1.00 |
| Gold PPO | 15.28 | 0.00 | 7.83 | 1.00 |
| DSNP Population | 14.75 | 0.00 | 6.89 | 1.00 |
| CMS Disability Flag population | 15.30 | 0.00 | 5.59 | 1.00 |
Percent of approved authorizations with extension
| Group | Percent |
| All in Medicare | 0.010% |
| Gold HMO | 0.006% |
| Gold PPO | 0.017% |
| DSNP Population | 0.005% |
| CMS Disability Flag population | 0.009% |
Standard authorizations approved after appeal
| Group | Overturned (approved) percent |
Number of overturned appeals | Total number of appeals |
| All in Medicare | 47.65% | 71 | 149 |
| Gold HMO | 47.06% | 40 | 85 |
| Gold PPO | 48.44% | 31 | 64 |
| DSNP Population | 0 | ||
| CMS Disability Flag population | 54.55% | 12 | 22 |
Manage your health with GHP member portal
Use the member portal to view claims and benefits, find a provider and more.
More Geisinger Gold member benefit information
Coverage decisions and appeals
Understanding decisions and filing appeals
Geisinger Gold Medicare Advantage HMO, PPO, and HMO D-SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company/Geisinger Quality Options, Inc., health plans with a Medicare contract. Continued enrollment in Geisinger Gold depends on contract renewal. Geisinger Health Plan, Geisinger Indemnity Insurance Company, and Geisinger Quality Options, Inc. are part of Geisinger, an integrated health care delivery and coverage organization. Risant Health is the parent organization of Geisinger.
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