2021 GEHA Medicare Benefits Guide

Elevate Plus + Medicare

Self Only premiums.

Medical benefits for Elevate Plus with Medicare A & B primary. What you pay in- or out-of-network. geha.com/Find-Care

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The in-network out-of-pocket maximum is the maximum amount of coinsurance and copays you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount. Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. difference in cost between the brand-name and the generic.

Enroll code 251 . geha.com/Enroll

– Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Lab, X-ray and diagnostic test services – MinuteClinic © (where available) geha.com/MinuteClinic

$163.28

Retirees monthly

X You pay $0 for medical deductibles, copays and coinsurance whether your provider is in- or out-of-network. X Earn up to $500 for Self Only or $1,000 for Self Plus One and Self and Family through Wellness Pays rewards. X Comprehensive drug list and mail order service for prescriptions. info.caremark.com/GEHA X $1,500 hearing aid benefit. X Digital tools to navigate your health care experience. Learn more at geha.com/ElevateLearn Medicare A & B primary members get rewarded for healthy living and enjoy mail order prescription benefits with affordable premiums.

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Self Plus One premiums.

Enroll code 253 . geha.com/Enroll

– Primary physician office visit – Specialist care; office visit – Urgent care – Emergency care

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$380.93

Retirees monthly

$0

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Self and Family premiums.

– Hospital care; inpatient and outpatient – Chiropractic care; up to 15 visits per year (spinal manipulation therapy) – Acupuncture; up to 20 treatments per year – Professional surgical services; inpatient and outpatient

Enroll code 252 . geha.com/Enroll

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$404.93

Retirees monthly

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How to enroll If you are a retired federal

Benefits included with your Elevate Plus plan. Unlimited telehealth visits with MDLIVE

Prescription benefits for Elevate Plus. What you pay in-network. 2,3 geha.com/Prescriptions

geha.com/MDLIVE geha.com/Vision geha.com/Hearing geha.com/Fitness geha.com/Toothbrush geha.com/Whitening geha.com/Healthline geha.com/LifeAlert geha.com/Screenings

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

Vision discount 6

$5 $80 4 40% 4 $12 $200 4 40% 4

Generic Preferred brand-name Non-preferred brand-name Generic Preferred brand-name Non-preferred brand-name

Hearing aid discount 6 Gym membership 6 Electric toothbrush 6 Teeth whitening 6 Health Advice Line Medical alert system 6 Biometric screening

30-day retail

90-day mail service

40% ($500 max 4 ) 40% 4

Generic and preferred brand-name Non-preferred brand-name

30-day 5 specialty CVS exclusive

Out-of-pocket max 1 for Elevate Plus. What you pay in-network. 2 Self Only Out-of-pocket max $6,000 Self Plus One, Self and Family Out-of-pocket max $12,000

This plan has no out-of-network pharmacy coverage and has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care

geha.com/Medicare 800.262.4342

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer that maintains your health benefits enrollment.

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www.geha.com

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