Geisinger Marketplace Direct 6 PA

Plan Information
Company Geisinger Health Plans
State PA
Metal Tier Silver
Plan Type PPO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,500 $5,000
Deductible (Family) $5,000 $10,000
Coinsurance 20% 30%
Out of Pocket Maximum (Individual) $5,500 $15,000
Out of Pocket Maximum (Family) $11,000 $30,000
Services In Network Out of Network
Primary Care Visit $25 30% coinsurance
Specialist Visit $50 30% coinsurance
In Patient Hospital Services 20% Coinsurance after deductible 30% coinsurance
Emergency Room Services $250 $250 copay
Mental / Behavioral Health $25 copay 30% coinsurance
Imaging (CT/PET Scans, MRIs) 20% coinsurance 30% coinsurance
Rehabilitative Speech Therapy $50 copay 30% coinsurance
Rehabilitative Occupational & Physical Therapy $50 copay 30% coinsurance
Preventative Care $0 30% coinsurance
Laboratory Outpatient and Professional Services 20% coinsurance 30% coinsurance
X-ray and Diagnostic Imaging 20% coinsurance 30% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $3
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $85 Copay after deductible
Specialty Drugs 50% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,500.00
Deductible (Family) $5,000.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Services In Network Out of Network
Primary Care Physician $20
Specialists $40
Emergency Room $200
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $3.00
Preferred Brand Rx $45
Non Preferred Brand Rx $80
Specialty Drugs 50% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $175.00
Deductible (Family) $350.00
Out of Pocket Maximum (Individual) $2,250.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $15
Specialists $25
Emergency Room $75
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $3.00
Preferred Brand Rx $35
Non Preferred Brand Rx $55
Specialty Drugs 40%

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $100.00
Deductible (Family) $200.00
Out of Pocket Maximum (Individual) $750.00
Out of Pocket Maximum (Family) $1,500.00
Services In Network Out of Network
Primary Care Physician $3
Specialists $10
Emergency Room $25
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx No Charge
Preferred Brand Rx $7
Non Preferred Brand Rx $20
Specialty Drugs 20%

Other Plans

Other plans that are available in the state.

Plan Name
Marketplace Direct 1
Marketplace Direct 10
Marketplace Direct 11
Marketplace Direct 12
Marketplace Direct 13
Marketplace Direct 3
Marketplace Direct 4
Marketplace Direct 5
Marketplace Direct 6
Marketplace Direct 8
Marketplace Direct 9
Marketplace Extra 1
Marketplace Extra 2
Marketplace Extra 3
Marketplace Solutions 1
Marketplace Solutions 10
Marketplace Solutions 11
Marketplace Solutions 12
Marketplace Solutions 13
Marketplace Solutions 3
Marketplace Solutions 4
Marketplace Solutions 5
Marketplace Solutions 6
Marketplace Solutions 8
Marketplace Solutions 9
Marketplace Value Catastrophic POS
Marketplace Value Catastrophic PPO
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.