Learn how GEHA’s five medical plans work with your Medicare benefits. Download the PDF for a 508-accessible document.
2022 GEHA MEDICARE BENEFITS Learn how GEHA’s five medical plans work with your
Medicare benefits. 800.262.4342
geha.com/Medicare
Medicare + GEHA All GEHA medical plans work with Medicare Parts A & B With a GEHA medical plan to supplement your Medicare coverage, a sudden hospital stay, a prolonged illness or a major surgical procedure won’t overwhelm your budget. geha.com/Medicare
Contents
02
Medicare + GEHA
03
Compare premiums for all plans
04
Vision benefits & discounts
05
Hearing aid benefits & discounts
05
NEW! Exclusive plan perk for Elevate & Elevate Plus subscribers in 2022
Elevate + Medicare
HDHP + Medicare
Standard + Medicare
Elevate Plus + Medicare
High + Medicare
Plan service
NEW! Choice of plan perk 1 NEW! $800 Medicare Part B reimbursement
Yes
Yes
No
No
No
06
Elevate + Medicare
Yes
No
No
No
No
08
HDHP + Medicare
Coverage for in- and out-of-network care 2
10
Standard + Medicare
Yes
Yes
Yes
Yes
Yes
12
Elevate Plus + Medicare
100% medical coverage (copays and deductibles waived) with Medicare A & B primary
14
High + Medicare
Yes
Yes
Yes
No
No
16
GEHA has a medical plan for your needs
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Mail service pharmacy
No No
Non-preferred drug coverage 3
Vision and hearing aid discounts or benefit 4,5, 6
Yes
Yes
Yes
Yes
Yes
Coverage for care outside of the United States
Yes
Yes
Yes
Yes
Yes
NEW! in 2022 Elevate and Elevate Plus subscribers can select a plan perk from several health and wellness options, including SilverSneakers fitness benefit for Elevate Plus only. To learn more, see page 5 or visit geha.com/PlanPerk
1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans. 2 Though the Elevate Plus plan on its own does not provide out-of-network medical coverage when it’s combined with Medicare and the provider accepts Medicare assignment, out-of-network cost shares are waived. There are no out-of-network pharmacy benefits for Elevate and Elevate Plus. 3 With High plan, when Medicare A & B is primary, you pay a lower coinsurance for preferred and non-preferred brand medications. 4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members. 5 The HDHP plan also includes additional vision benefits. Learn more at geha.com/HDHPVision 6 Standard, Elevate Plus and High also include additional hearing aid benefits. Learn more at geha.com/Hearing
02 2022 GEHA MEDICARE BENEFITS
Compare premiums for all plans If you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management at opm.gov
Elevate What you pay
HDHP What you pay
Standard What you pay
Elevate Plus What you pay
High What you pay
Self only
Enrollment codes
254
341
314
251
311
$105.61
$136.95
$135.77
$171.44
$227.20
Monthly (retirees)
Elevate What you pay
HDHP What you pay
Standard What you pay
Elevate Plus What you pay
High What you pay
Self Plus One
Enrollment codes
256
343
316
253
313
$242.90
$294.44
$291.92
$395.44
$530.31
Monthly (retirees)
Elevate What you pay
HDHP What you pay
Standard What you pay
Elevate Plus What you pay
High What you pay
Self and Family
Enrollment codes
255
342
315
252
312
$295.71
$361.83
$357.17
$413.04
$654.87
Monthly (retirees)
Free e-books and videos Learn more about your options with Medicare and GEHA at geha.com/Medicare
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.
03 2022 GEHA MEDICARE BENEFITS
Vision benefits & discounts With all GEHA medical plans, you get low copays on eye exams, and discounts on frames and lenses through EyeMed. ™ The EyeMed network includes LensCrafters, Target Optical, independent eye doctors and top optical retailers. Members also save on LASIK at participating locations. To learn more, visit geha.com/Vision Examples of what you pay for common in-network vision services for all plans. 1
Elevate and Elevate Plus What you pay
Standard and High What you pay
HDHP What you pay
Vision service
$0
$5
$5
Eye exams, retail price
$0 under $100 plus 80% over $100
60% of price
60% of price
Frames, retail price
Eyeglass lenses, standard plastic single vision, retail price Up to $50
Up to $50
$10
$10 under $110 plus 85% over $110
85% of price
85% of price
Contact lens, conventional retail price
GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through EyeMed. Learn more about this benefit at geha.com/HDHPVision
Included in all plans
$0 telehealth visits 2 geha.com/MDLIVE Free 24/7 Health Advice Line geha.com/Healthline
Medical alert system discount 1 geha.com/LifeAlert Gym membership discount 1 geha.com/Fitness
Electric toothbrush discount 1,3 geha.com/Toothbrush Teeth whitening discount 1 geha.com/Whitening
1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members. 2 If deductible is met, HDHP member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charge. 3 The cariPRO TM premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price.
04 2022 GEHA MEDICARE BENEFITS
NEW! Exclusive plan perk for Elevate & Elevate Plus subscribers in 2022
Hearing aid benefits & discounts All five GEHA plans offer access to TruHearing’s discounted pricing. 1 Three plans – Standard, Elevate Plus and High – also offer a hearing aid benefit. This benefit is per person, every 36 months for adults. TruHearing discount pricing can be combined with the hearing aid benefit for even greater savings. Find more information and hearing aid savings examples at geha.com/Hearing
GEHA’s unique position as a nonprofit member association allows us to offer this plan perk. We don’t have stockholders, which means our priority is putting money back into supporting our members. Beginning in 2022, Elevate and Elevate Plus plan subscribers are eligible annually to choose one plan perk from the following options:
SilverSneakers Exclusively for Elevate Plus plan subscriber and spouse enrolled in Medicare Part A and/or B
Fitbit wearable device including monthly Fitbit Premium Membership
What GEHA pays for hearing aid benefit.
Standard
Elevate Plus
High
$125 gift card for DICK’S Sporting Goods or REI
$2,500
$1,500
$2,500
Daily Burn virtual fitness subscription
Learn more at geha.com/PlanPerk
1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members.
These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.
05 2022 GEHA MEDICARE BENEFITS
Elevate + Medicare geha.com/Elevate 800.262.4342 • GEHA’s lowest premium plan • Low copays for non-traditional care, like chiropractic and acupuncture • Engaging digital wellness portal powered by Rally ® How this plan pays you back • NEW! Subscribers can select an annual plan perk. See page 5. geha.com/PlanPerk • Earn Wellness Pays rewards up to $500 (Self Only) or $1,000 (Self Plus One or Self and Family) annually geha.com/WellnessPays
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
254
256
255
Enrollment codes Monthly – retired
$105.61 $295.71 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. $242.90
Yearly deductible in-network 1
What you pay
$500
Self Only
$1,000
Self Plus One and Self and Family
What you pay
Prescription benefits in-network 1 ,2,3
• 30-day retail generic
$4
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
50% ($500 max)
100%
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
50% ($500 max)
100%
Check prescription costs at geha.com/Prescriptions
Health care style: wellness-focused, cost-conscious
To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care
How often you use your plan
Low
Average
High
Prescription medication need
Low
Average
High
1 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’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care
06 2022 GEHA MEDICARE BENEFITS
Included with Elevate
Medical benefits with Medicare A & B primary in-network 1
What you pay
Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 5 (see page 4) geha.com/Vision Hearing aid discount 5 geha.com/Hearing Gym membership discount 5 geha.com/Fitness Electric toothbrush discount 5 geha.com/Toothbrush Teeth whitening discount 5
• Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Primary physician office visit • MinuteClinic © (where available) geha.com/MinuteClinic • Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year • Acupuncture; up to 20 treatments per year
$0
$10
• Specialist care; office visit
$25 $50
• Urgent care
• Emergency care • Hospital care; inpatient and outpatient • Outpatient professional surgical services • Inpatient professional surgical services
25% 2
$250
geha.com/Whitening For a complete list of included benefits visit geha.com/Savings
Out-of-pocket maximum in-network 1 ,3
What you pay
$7,000 $14,000
Self Only
Self Plus One and Self and Family
5 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.
NEW! Subscribers can select an annual plan perk. Options include a Fitbit wearable device including Monthly Premium Membership, $125 gift card for DICK’S Sporting Goods or REI, or a Daily Burn virtual fitness subscription. 4 See page 5. geha.com/PlanPerk
Ready to enroll? opm.gov | 800.332.9798
1 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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Calendar year deductible applies. 3 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles 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. 4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.
07 2022 GEHA MEDICARE BENEFITS
HDHP + Medicare geha.com/HDHP 800.262.4342 • Low premiums with a lower net deductible than many traditional FEHB plans • GEHA contributes to your HRA. Use your HRA money to reduce your net deductible or reimburse Medicare premiums. How this plan pays you back • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HRA
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
341
343
342
Enrollment codes Monthly – retired
$136.95 $361.83 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. $294.44
Yearly deductible you pay after GEHA contribution to your HRA 2
Yearly deductible in-network 1
Plan type
$600
$1,500 $3,000
Self Only
$1,200
Self Plus One and Self and Family
What you pay
Prescription benefits in-network 1 ,3,4
• 30-day retail generic
25% 25% 5 40% 5 25% 25% 5 40% 5 25% 5 40% 5
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
• 90-day mail service generic
• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name
Health care style: analytical consumer, focused on savings
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
How often you use your plan
Check prescription costs at geha.com/Prescriptions
Low
Average
High
Prescription medication need
1 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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure 2 The net deductible is the remaining amount after you subtract the annual GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin. 3 Calendar year deductible applies. 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Low
Average
High
08 2022 GEHA MEDICARE BENEFITS
Included with HDHP
Medical benefits with Medicare A & B primary in-network 1
What you pay
Telehealth visits, including behavioral health and dermatology 2,3 geha.com/MDLIVE Vision benefit and discount 5 (see page 4) geha.com/HDHPVision Hearing aid discount 5 geha.com/Hearing Gym membership discount 5 geha.com/Fitness Electric toothbrush discount 5 geha.com/Toothbrush Teeth whitening discount 5 geha.com/Whitening Medical alert system discount 5
• Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE
$0
2,3
• Preventive care; adult routine screenings • Preventive dental care, twice yearly
$0
• Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • MinuteClinic © (where available) geha.com/MinuteClinic • Lab services • Other diagnostic services • Professional surgical services • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year • Acupuncture; up to 20 treatments per year
5% 2
geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings
Out-of-pocket maximum in-network 1,4
What you pay
$5,000 $10,000
Self Only
Self Plus One and Self and Family
5 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.
Additional vision benefit with HDHP . GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through EyeMed. 5 Learn more at geha.com/HDHPVision
Ready to enroll? opm.gov | 800.332.9798
1 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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure 2 Calendar year deductible applies. 3 If the deductible is met, high deductible health plan (HDHP) member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charges. 4 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles 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.
09 2022 GEHA MEDICARE BENEFITS
Standard + Medicare geha.com/Standard 800.262.4342
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
314
316
315
Enrollment codes Monthly – retired
$135.77 $357.17 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. $291.92
• Good choice for Medicare A & B primary members who take generic prescriptions • $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network, even outside the United States • $0 for inpatient and outpatient hospital services, surgeries and office visits • $2,500 hearing aid benefit and additional discount How this plan pays you back • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards
Yearly deductible with Medicare A & B primary
What you pay
$0 $0
Self Only
Self Plus One and Self and Family
Prescription benefits in-network 1,2
What you pay
• 30-day retail generic
$10
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
50% ($200 max 3 ) 50% ($300 max 3 )
• 90-day mail service generic
$20
• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name
50% ($500 max 3 ) 50% ($600 max 3 ) 50% ($250 max 3 ) 50% ($400 max 3 )
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
Health care style: traditional coverage to stay on a healthy path
Check prescription costs at geha.com/Prescriptions
How often you use your plan
Low
Average
High
Prescription medication need
Low
Average
High
1 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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
10
2022 GEHA MEDICARE BENEFITS
Included with Standard
With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Professional surgical services; inpatient and outpatient • Outpatient professional and facility High Tech Imaging (MRI, CT, PET, etc.) • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
What you pay
Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 3 (see page 4) geha.com/Vision Hearing aid benefit and discount 3 geha.com/Hearing Gym membership discount 3 geha.com/Fitness Electric toothbrush discount 3 geha.com/Toothbrush Teeth whitening discount 3 geha.com/Whitening Medical alert system discount 3
$0
• Preventive dental care; twice yearly
50%
geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings
Out-of-pocket maximum in-network 1 ,2
What you pay
$6,500 $13,000
Self Only
Self Plus One and Self and Family
3 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.
Ready to enroll? opm.gov | 800.332.9798
1 Refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles 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.
11
2022 GEHA MEDICARE BENEFITS
Elevate Plus + Medicare geha.com/ElevatePlus 800.262.4342 • You pay $0 for medical deductibles, copays and coinsurance • Engaging digital wellness portal powered by Rally ® • $1,500 hearing aid benefit and added discounts How this plan pays you back • NEW! Subscribers can select an annual plan perk. See page 5. geha.com/PlanPerk • Earn Wellness Pays rewards up to $500 (Self Only) or $1,000 (Self Plus One or Self and Family) annually geha.com/WellnessPays
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
251
253
252
Enrollment codes Monthly – retired
$171.44 $413.04 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. $395.44
Yearly deductible with Medicare A & B primary
What you pay
$0 $0
Self Only
Self Plus One and Self and Family
Prescription benefits in-network 1,2,3
What you pay
• 30-day retail generic
$10 $80 4 50% 4
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
• 90-day mail service generic
$20
• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name
$200 4 50% 4
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
40% ($500 max 4 )
50% 4
Health care style: health-focused, proactive and values predictable pricing
Check prescription costs at geha.com/Prescriptions
How often you use your plan
No out-of-network pharmacy and a limited pharmacy network. Find a provider or a pharmacy at geha.com/Find-Care
Low
Average
High
Prescription medication need
1 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’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 This plan has no out-of-network pharmacy coverage and a limited pharmacy network. Find a pharmacy at geha.com/Find-Care 4 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Low
Average
High
12
2022 GEHA MEDICARE BENEFITS
Included with Elevate Plus
With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE
What you pay
Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 4 (see page 4) geha.com/Vision Hearing aid benefit and discount 4 geha.com/Hearing Gym membership discount 4 geha.com/Fitness Electric toothbrush discount 4 geha.com/Toothbrush Teeth whitening discount 4 geha.com/Whitening Medical alert system discount 4
• Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Chiropractic care (manipulative therapy), including X-rays; up to 15 visits per year • Acupuncture; up to 20 treatments per year • Professional surgical services; inpatient and outpatient $0
Out-of-pocket maximum in-network 1 ,2
What you pay
geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings
$6,000 $12,000
Self Only
Self Plus One and Self and Family
NEW! Subscribers can select an annual plan perk. Options include a SilverSneakers fitness benefit, a Fitbit wearable device including monthly Fitbit Premium Membership, a $125 gift card for DICK’S Sporting Goods or REI, or a Daily Burn virtual fitness subscription. 3 See page 5. geha.com/PlanPerk
4 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.
Ready to enroll? opm.gov | 800.332.9798
1 Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 The 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. 3 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.
13
2022 GEHA MEDICARE BENEFITS
High + Medicare geha.com/High 800.262.4342 • Comprehensive brand-name and specialty prescription coverage • You pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network, even outside the United States • You pay $0 for inpatient and outpatient hospital services, surgeries and office visits • $2,500 hearing aid benefit and added discount How this plan pays you back • NEW! $800 Medicare Part B reimbursement geha.com/MRA • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
311
313
312
Enrollment codes Monthly – retired
$227.20 $654.87 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. $530.31
Yearly deductible with Medicare A & B primary
What you pay
$0 $0
Self Only
Self Plus One and Self and Family
Prescription benefits in-network 1,2
What you pay
• 30-day retail generic
$10 3
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
20% ($150 max 3,4 ) 35% ($200 max 3,4 )
• 90-day mail service generic
$15
• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name
15% ($350 max 4 ) 30% ($500 max 4 )
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
15% ($150 max 4 )
Health care style: maximum coverage and dependable support
30% ($200 max 4 )
How often you use your plan
Check prescription costs at geha.com/Prescriptions
Low
Average
High
Prescription medication need
1 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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. 4 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Low
Average
High
14
2022 GEHA MEDICARE BENEFITS
Included with High
With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Professional surgical services; inpatient and outpatient • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
What you pay
Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 3 (see page 4) geha.com/Vision Hearing aid benefit and discount 3 geha.com/Hearing Gym membership discount 3 geha.com/Fitness Electric toothbrush discount 3 geha.com/Toothbrush Teeth whitening discount 3 geha.com/Whitening Medical alert system discount 3
$0
Balance after GEHA pays $22 per visit
• Preventive dental care
geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings
Out-of-pocket maximum in-network 1 ,2
What you pay
$5,000 $10,000
Self Only
Self Plus One and Self and Family
3 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.
Ready to enroll? opm.gov | 800.332.9798
1 Refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 The 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.
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2022 GEHA MEDICARE BENEFITS
GEHA has a medical plan for your needs Choose from five unique medical plans designed to meet you where you are in life.
Talk to a Benefits Adviser 800.262.4342
Ready to enroll? If you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. opm.gov | 800.332.9798
OPM Open Season online system retireefehb.opm.gov/Annuitant Explore how GEHA medical plans work with Medicare geha.com/Medicare Search our extensive nationwide network geha.com/Find-Care Check prescription costs geha.com/Prescriptions Learn about coverage outside the United States geha.com/OutsideUSA
This is a brief description of the features of Government Employees Health Association, Inc.‘s medical plans. Before making a final decision, please read the GEHA Federal brochures which are available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure. For information and changes to GEHA’s medical plans, see our three plan brochures – RI 71-006 (High and Standard Options), RI 71-014 (HDHP) and RI 71- 018 (Elevate and Elevate Plus) – which are available at geha.com/PlanBrochure Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information: The Federal Employees Health Benefit (FEHB) program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. GEHA’s SBCs are available on the internet at geha.com/SBC . Paper copies are also available, free of charge, by calling 800.821.6136 . To find out more information about plans available under the FEHB program, including SBCs for other FEHB plans, please visit opm.gov/Insure ©2021-2022 Government Employees Health Association, Inc. All rights reserved. Please recycle.
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