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Geisinger Health PlanMedicare Advantage · Coverage · Regulatory · PAHigh impact

Special Enrollment Period for Geisinger Gold and Medicare Advantage patients

Act
by Dec 31, 2025
Effective date
Jan 1, 2026
Identified
Jul 29, 2026

Summary

Geisinger Health Plan is discontinuing the Preferred Enhanced Rx (PPO) Medicare Advantage plan statewide and reducing Classic 360 Rx (HMO) coverage to exclude 11 Pennsylvania counties effective January 1, 2026. Affected members must enroll in a new Medicare Advantage plan by December 31, 2025, or coverage will revert to Original Medicare with loss of prescription drug benefits. A Special Enrollment Period is available through February 28, 2026.

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What to do

by Dec 31, 2025 · 7 steps
01Billing and front-desk teams must identify all active patients enrolled in Geisinger Gold Preferred Enhanced Rx (PPO) or Classic 360 Rx (HMO) in the 11 affected counties (Adams, Bradford, Carbon, Cumberland, Dauphin, Franklin, Lebanon, Perry, Schuylkill, Wayne, York).
02Create outreach list and contact these patients to inform them of plan discontinuation and enrollment deadline.
03Provide patients with Medicare.gov resources and Geisinger Gold Customer Service contact (800-498-9731).
04Update patient records to flag coverage status changes effective January 1, 2026.
05Verify all affected patients have enrolled in alternative Medicare Advantage plans or will transition to Original Medicare before year-end.
06After January 1, 2026: Billing team must verify coverage status for all affected patients in claims processing system to ensure claims route to correct Medicare Advantage plan or Traditional Medicare.
07Process any claims for affected patients carefully to prevent denials due to coverage gaps or plan transitions.

Original notice

Special Enrollment Period for Geisinger Gold and Medicare Advantage patients
geisinger.org · Always check the source before changing claims.
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