Medicare AdvantageCoverageHigh impact
Special Enrollment Period for Geisinger Gold and Medicare Advantage patients
Geisinger Health Plan·PA·Regulatory
Effective date
Jan 1, 2026
We identified it
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.
Action Required
By December 31, 2025: Billing 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). Create outreach list and contact these patients to inform them of plan discontinuation and enrollment deadline. Provide patients with Medicare.gov resources and Geisinger Gold Customer Service contact (800-498-9731). Update patient records to flag coverage status changes effective January 1, 2026. Verify all affected patients have enrolled in alternative Medicare Advantage plans or will transition to Original Medicare before year-end. After 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. Process any claims for affected patients carefully to prevent denials due to coverage gaps or plan transitions.