Marketplace frequently asked questions

This is your share of the costs of a covered healthcare service, which is a percent of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. Your insurance plan pays for the rest of the allowed amount.

The maximum out-of-pocket (MOOP) amount includes all member cost-sharing, such as deductibles, coinsurance and copays, for all covered services in a policy period. MOOP doesn't include your monthly premium. Once your maximum out-of-pocket costs are met, your insurance plan will pay 100% of costs for covered services.

A fixed amount you pay for a covered healthcare service, usually paid at the time you receive the service. The amount can vary depending on your plan and the type of service you are receiving.

This is the amount you pay monthly for your policy. Premiums vary based on the plan you choose. Plans that have a higher deductible will typically cost less.

Under the Affordable Care Act (also known as the ACA, or healthcare reform), the below metallic tiered categories are based on how you and your plan divides your healthcare costs. There are four metallic levels: bronze, silver, gold and platinum.

Geisinger Health Plan offers three metallic levels: bronze, silver and gold.

• Bronze: Your health plan pays 60% on average. You pay about 40%.
• Silver: Your health plan pays 70% on average. You pay about 30%.
• Gold: Your health plan pays 80% on average. You pay about 20%.

As you go from bronze to gold, the monthly premiums tend to go up. So, a bronze plan would generally have a lower premium than a gold plan.

Need more guidance? Call us at 800-223-1282.

HMO (health maintenance organization)
With an HMO plan, you select a primary care physician (PCP) who will help manage your health and wellness. HMOs generally cost less because you use in-network providers.

POS (point of service)
With POS, you choose a PCP to help coordinate your care. You can see other healthcare providers — in or out of our network. You will pay more for services received from providers outside our network.

PPO (preferred provider organization)
With a PPO, you don’t need to choose a PCP. You can see other healthcare providers — in or out of our network. You will pay more for services received from providers outside our network.

Geisinger Extra
With our Geisinger Extra plans, if you visit a primary care site designated as a "Geisinger Extra" site, you will pay lower office visit copays. Some Geisinger Extra sites are also ProvenHealth Navigator^® locations, where extra care is provided because the office is staffed with a Geisinger Health Plan nurse.

Geisinger Extra plans are only available in select counties. See a list of Geisinger Extra sites.

QHDHP
A qualified high-deductible health plan (QHDHP) has lower premiums and higher deductibles than a traditional insurance plan. You must have a QHDHP to have a health savings account.

View our Geisinger Marketplace plans online or call us at 800-223-1282, Monday through Friday, 8 a.m. to 5 p.m.

These counties are included in our coverage area:

• Adams
• Bedford
• Berks
• Blair
• Bradford
• Cambria
• Cameron
• Carbon
• Centre
• Clearfield
• Clinton
• Columbia
• Cumberland
• Dauphin
• Elk
• Franklin
• Fulton
• Huntingdon
• Jefferson
• Juniata
• Lackawanna
• Lancaster
• Lebanon
• Lehigh
• Luzerne
• Lycoming
• Mifflin
• Monroe
• Montour
• Northampton
• Northumberland
• Perry
• Pike
• Potter
• Schuylkill
• Somerset
• Snyder
• Sullivan
• Susquehanna
• Tioga
• Union
• Wayne
• Wyoming
• York

The Open Enrollment Period begins every year on Nov. 1 and continues through Jan. 15. When you enroll:

• Nov. 1 – Dec. 15: Coverage starts Jan. 1
• Dec. 15 – Jan. 15: Coverage starts Feb. 1.

Missed open enrollment? You may still be able to enroll if you have a qualifying life event (QLE).

Shop for and enroll in a Geisinger Marketplace plan online or call us at 800-223-1282, Monday through Friday, 8 a.m. to 5 p.m.

You can also enroll through Pennie^®, Pennsylvania's state-based exchange, online or by calling 844-844-8040 to find information and assistance on your health insurance.

Depending on your income, you may be eligible for financial help for health insurance. If you don't qualify for financial help from Pennie^®, you may have other options. The easiest way to determine eligibility is by completing a Pennie application. Contact Geisinger Health Plan directly for questions about how to complete an application.

Depending on your circumstances, it's possible to qualify for both advance premium tax credits and cost-sharing reductions.

To see if you qualify, call a GHP agent at 800-918-5154 or visit pennie.com.

The chart below represents household incomes and sizes at 138% of the federal poverty level. In most cases, individuals and families making at or above these figures could qualify for the advanced premium tax credit.