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In 1972, Geisinger Medical Center in Danville, Pennsylvania began a pilot program to offer managed health care insurance coverage to its employees as well as local residents. The plan was given authorization by the state to operate as an HMO in 1985, and began expansion into other counties. By 1990 the plan had 100,000 members.
The Affordable Care Act brought changes that led to further expansion of the Health Plan, and in 2012 it was offered outside of Pennsylvania for the first time. Today some of the products are available in three additional states: Delaware, Maine, and New Jersey. The company website states that there are more than 500,000 members.
Geisinger started out offering only HMO plans, which means that provider access is generally limited to those within the health system. This keeps premiums lower but also generally means more rules regarding what provider you can see and requirements for referrals. They have since added a selection of PPO options, which allow for a wider network of providers, but may be more costly.
The company sells products through agents and brokers as well as directly. Their headquarters remains in Danville, PA.
Currently, Geisinger offers Medicare Advantage Plans only in a specific area, and lists all of the included counties clearly on the website. There are both HMO and PPO plans to choose from, as well as a plan intended for those who qualify for both Medicare and Medicaid.
Gold Classic Advantage (HMO)
The Gold Classic Advantage plans are HMO plans, with three different options available.
The first two are Classic Advantage and Classic Advantage Rx, with the only difference between them being the addition of Part D prescription drug coverage with the Rx plan. Medical coverage is the same with or without Part D.
This plan does not have a deductible and does not charge a co pay for a primary care provider office visit. The co pay to see a specialist is $20, and Urgent Care is the same. Emergency care is at the standard $75 co pay. Inpatient hospital care is covered with a $150 per day co pay for the first five days and no charge thereafter. The plan includes hearing, dental, ad vision benefits as well. Co pays are low across the board for this plan.
The addition of the Rx coverage provides a $0-deductible plan in which Tier 1 drugs start at a $3 co pay. Tier 2 is $20, Tier 3 $47, Tier 4 $100, and Tier 5 is covered with a 33% coinsurance.
Classic Complete Rx is the $0 premium (on top of Original Medicare premiums) plan from Geisinger. It is also a $0-deductible plan that includes Part D drug coverage but only has limited benefits for hearing, dental and vision. These can be upgraded for an added premium with the Health+ option.
Co pays on the Complete plan are a little higher: $5 for a primary care visit, $35 for a specialist or Urgent Care visit, and the same $75 for emergency care. Inpatient hospital care has a $175 per day co pay for the first 5 days. Prescription drug coverage for the Complete plan is the same as that on the other HMO option.
The Health+ plan can be added to the Complete plan to get additional benefits including more vision, dental, and hearing coverage, and a fitness allowance.
Gold Preferred Advantage (PPO)
Geisinger offers two PPO plans, both of which include Part D coverage. These plans offer a wider network of care than do HMOs. These plans offer only the dental and vision benefits that are part of Original Medicare, and no hearing coverage. Hearing and enhanced dental and vision coverage can be added with the Health+ package.
The Preferred Complete Rx is the PPO version of the $0 added premium Classic HMO plan. This plan has a $5 co pay for primary care visits and a $40 co pay for specialist and Urgent Care, as well as the standard $75 emergency care co pay. Inpatient hospital care is $200 for the first five days, and no charge thereafter.
The Preferred Advantage Rx plan has a $5 primary care co pay, and $25 for specialists and Urgent Care, as well as the same emergency co pay of $75. Inpatient hospital stays are covered with a $175 per day co pay for the first five days.
Both plans offer the same Part D coverage, which has the same co pays as the HMO options.
As a small regional insurer, Geisinger’s rates are not easily comparable to nationwide companies. They do not offer coverage in our sample comparison area, so we are unable to determine how they stack up in terms of value.
Finding rates, however, is relatively easy on the website, as they are listed with the summary of benefits for each plan. Rates for the HMO plans vary. The Complete is a $0 monthly premium, unless you choose to add Health+, which carries a premium of $38 per month. The other HMO premiums are determined based on the county of residence. They range from $30-90 per month without Part D coverage and $117-147 for the option that includes prescription coverage.
Rates are flat for the PPO plans, with the Complete being a $0 monthly charge and the Advantage coming in at $75 per month. Health+ can again be added for $38 per month.
Ratings and Reviews
We were unable to find a Better Business Bureau (BBB) record for Geisinger Health Plan, but there is a record for theGeisinger Health System. Currently the company carries a D- rating, which according to the BBB is due to their failure to respond to nine complaints filed against them. The BBB deducts heavily from a company’s rating when they fail to respond to complaints; this often impacts the rating more than the actual number of complaints. There have been 19 complaints in the past three years, three complaints were closed in the past 12 months.
Geisinger’s HMO has an overall rating of 4.0 from NCQA, but it’s worth noting that the plan was ranked low almost entirely across the board in terms of customer satisfaction, earning back points in other areas that might be far less important to insurance customers. An overall score of 2.5 for customer satisfaction is not quite balanced by a good record for ensuring children have their well visits. The PPO plans are rated under a different name, and also have a 4.0 rating, with a slightly better rating in customer satisfaction. These ratings reflect all of the company’s plans and not only Medicare.
Geisinger’s HMO plans have received a 4.5 star rating from Medicare.
We were unable to locate any user reviews for Geisinger, likely due to the fact that it’s a small, regional insurance company. That means we are unable to provide a view of what actual members of the health plan have experienced, and have only a few ratings on which to base an opinion.
The Bottom Line
Geisinger offers very reasonably priced Medicare plans for residents of certain counties in Pennsylvania. While many of the ratings appear good on the surface, a little digging does raise a few red flags. Overall, the company’s PPO plans appear to be a better bet for those seeking a combination of good pricing, good coverage, and good ratings. We’d like to see the customer satisfaction scores come up, however, before recommending Geisinger.
For a list of companies that we recommend, visit our Best Insurance Companies page.