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
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