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Medicare questions and answers

Feel like insurance coverage is a little complicated? Find answers to the most common questions we hear.

Already a Geisinger Gold member?

Click below to find information on benefit documents, filing grievances, coverage determinations and more.

When it comes to Medicare and Medicare Advantage, you need information to make the right choices for yourself. Read on for the answers to our most frequently asked questions:

Enrollment questions

When will I receive my Geisinger Gold insurance card?

You'll receive your card after Medicare and Geisinger Gold confirm your eligibility. The timeframe for this varies, but most cards will be mailed within ten days of enrollment. You can also log in to your account to view your card as soon as it’s available.

Should I cancel my current insurance? 

No, you should never cancel any existing insurance until you have received verification of acceptance with another plan. You may also be required to put that in writing for your current insurer.

When will I get the first Geisinger Gold bill? 

That depends on the billing cycle and when you get Medicare's approval. In most cases, the first bill (if not electronically deducted from a savings/checking/credit card or Social Security check) will be a double bill until the billing cycle puts it in a routine mailing.

Can I change my payment method for Geisinger Gold if I get a bill and then want it deducted from my checking/savings/credit card account? 

You can arrange with the customer care team to have your premiums deducted from a checking/savings/credit card. You can also log in to your account to manage or update your payment method. 

Will I be enrolled in Geisinger Gold right away?

The application needs to be verified by Medicare. Wait until you receive your confirmation letter to cancel any current coverage.

Where do I mail an enrollment application?

A pre-printed envelope was provided with your application. If you don’t have it, mail the application to:

Geisinger Gold
Attn. Enrollment 32-29
P.O. Box 900
Danville, PA 17821-9979

For the emergency contact, should I list someone who doesn’t live with me?

That’s your choice. A lot of people choose their spouse. Others choose an adult child outside of their home. Some choose a friend. Note that the application contains space for only one contact/telephone number.

Where can I find the "PCP Number" requested on the Gold application?

You can use our online Provider Search tool to see if your primary care physician (PCP) is available with Geisinger Gold. You will find the PCP Number next to each doctor’s name in the search results. You can also contact Geisinger Gold at 800-498-9731 (TTY: 711), Monday - Friday, 8 a.m. - 8 p.m., for assistance.

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, 2021, for Geisinger Gold or Part D, when will my coverage become effective?

Your coverage will become effective on Jan. 1, 2022.


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:

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 2021?

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:

  • Opioid prescriptions are monitored for safe dosage levels. If an opioid prescription is above a safe dosage limit, the prescription will be stopped at the pharmacy for review by the provider to make sure it’s medically necessary and appropriate. 
  • Opioid prescriptions that are taken together with benzodiazepine prescriptions will be stopped at the pharmacy for review by the provider to make sure the prescriptions are medically necessary and appropriate. 
  • Members who haven’t had a recent prescription for opioids will be limited to no more than a 7-day supply for their first opioid prescription for the treatment of acute pain.
    Prescriptions for long-acting opioids that are taken at the same time will be stopped at the pharmacy for review by the provider to make sure the prescriptions are medically necessary and appropriate.  

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.

Find covered drugs & pharmacies

Where can I see what drugs are covered?

View 2021 Drug Plan Formularies

Where can I find in-network pharmacies?

Geisinger Gold has contracts with pharmacies that meet or exceed CMS requirements for pharmacy access in your area. Our pharmacy network includes nearly 3,000 retail pharmacies, both large chain pharmacies and neighborhood drug stores, throughout Pennsylvania.

Find a pharmacy near you

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:
  • 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

Contact us today!

Our Geisinger Gold Medicare Advisors are standing by and are ready to help you on your Medicare journey. 

Call 800-482-8163 (TTY: 711)
Geisinger Gold Medicare Advantage HMO, PPO, and HMO SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company, health plans with a Medicare contract. Continued enrollment in Geisinger Gold depends on annual contract renewal.
 
Y0032_21210_12_M Accepted 8/3/21
Last updated 8/3/21