Medicare questions and answers

Do I have to enroll in a Medicare prescription drug plan (Part D)?

You don’t have to enroll in Medicare Part D. However, even if you’re not currently taking many (or any) prescription drugs, you should still consider joining a plan. That way, if things change, you’ll have the coverage you need. 

If you wait to enroll in a Medicare prescription drug plan, you may have to pay a penalty for joining late.

What if I didn’t join a Medicare prescription drug plan when it was first offered?

If you were eligible and didn’t sign up for a plan by May 15, 2006, and since then you didn’t have a drug plan that covers as much or more than a Medicare prescription drug plan, you may have to pay more each month.

Can I enroll in a standalone Medicare prescription drug plan if Geisinger Gold’s Medicare plan already includes prescription drug coverage, along with the medical coverage (an MAPD plan)?

No. If you purchase a standalone Medicare drug plan while you're enrolled in a Medicare Advantage plan with prescription drug coverage (MAPD), you'll be automatically disenrolled from the MAPD plan.

If I enroll between Oct. 15 and Dec. 7 for Geisinger Gold, when will my coverage become effective?

Your coverage will become effective on Jan. 1 of the following year.

What is the State Pharmaceutical Assistance Program and how do I apply?

Pennsylvania’s State Pharmaceutical Assistance Programs, called PACE and PACENET, work with both Medicare and Geisinger Gold to ensure eligible Pennsylvanians have quality drug coverage at the lowest possible cost. 
To speak with a PACE/PACENET representative, call toll-free:

• 866-712-2060, Monday – Friday, 9 a.m. – 5 p.m.

You can also contact Geisinger Gold for help at:

• 800-498-9731, Monday – Friday, 8 a.m. – 8 p.m.
  • TTY users should call 711

What prescriptions are covered by Geisinger Gold? 

Geisinger Gold may add or remove drugs from our formulary during the year. For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY/TDD: 711), 7 days a week, 8 a.m. – 8 p.m.

If we remove drugs from our formulary; add prior authorization, quantity limits and/or step therapy restrictions on a drug; or move a drug to a different tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and notify members who take the drug.

Geisinger Gold covers both brand-name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. They usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

Are there financial assistance options available for prescription drugs? 

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:

• 800-MEDICARE (800-633-4227) (TTY users call 877-486-2048), 24 hours a day, 7 days a week
• The Social Security Office at 800-772-1213 (TTY users call 800-325-0778) between 7 a.m. and 7 p.m., Monday through Friday.
• Your state Medicaid office

What are the opioid policies for 2024?

The opioid epidemic and its effect on our communities is a prime concern. One way of combating this public health emergency is via drug management programs that prevent opioid overuse:

• Opioids are limited to a 7-day supply for members who are not already established on opioid therapy.
• Opioids will require health plan review when a member is receiving multiple long-acting opioids or a combination of opioids and benzodiazepines.
• All Part D plans have a drug management program that limits access to controlled substances that are frequently abused drugs (currently defined as opioids and benzodiazepines) for members at risk for prescription drug abuse or misuse. The goal of drug management programs is better care coordination for safer use of these drugs.

You may be exempt from these drug management programs if you

• Have an active cancer diagnosis
• Have a diagnosis of sickle cell anemia
• Are in a hospice or long-term care facility

For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY: 711), 7 days a week, 8 a.m. – 8 p.m.

You may also contact your provider with any medication-related questions.

Medicare questions

What else do I need to know about Geisinger Gold and Part D coverage? 

If you purchase a standalone Medicare drug plan while you're enrolled in a Medicare Advantage plan with prescription drug coverage (MAPD), you'll be automatically disenrolled from the MAPD plan.

Members must get their prescriptions from network pharmacies. In case of emergency, members may go to a non-network pharmacy. You may only enroll in one prescription drug plan at a time. If you are enrolled in a Medicare Advantage plan that offers prescription drug coverage, you must take your prescription drug coverage from that plan. You can’t enroll in a standalone prescription drug plan unless you disenroll from your Medicare Advantage plan. If you’re enrolled in a Medical Savings Account plan, you can enroll in a standalone prescription drug plan. Prescription drug coverage from Geisinger Gold is offered exclusively to Geisinger Gold members.

Learn more about exceptions and appeals regarding your prescription coverage.

In what counties are Geisinger Gold Medicare Advantage plans offered?

Geisinger Gold plans for individuals are available in these specific counties: