Medical benefits with Medicare A & B primary in-network 1,2
You pay
Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Lab, X-ray and diagnostic test services
MinuteClinic ® where available Primary physician office visit
Mental health office visit Specialist care office visit Urgent care facility ER visit Hospital care; inpatient and outpatient Professional surgical services; inpatient and outpatient Outpatient professional High Tech Imaging (MRI, CT, PET, etc.) Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
$0
$5
Vision coverage; eye exams 3
50%
Preventive dental care, twice yearly
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. 2 With Medicare A & B primary, go to any provider that accepts Medicare assignment. 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.
Prescription benefits in-network 1,2
You pay
$10
30-day retail generic
50% ( $200 max 3 )
30-day retail preferred brand-name
50% ( $300 max 3 )
30-day retail non-preferred brand-name
$20
90-day mail service generic
50% ( $500 max 3 )
90-day mail service preferred brand-name
50% ( $600 max 3 )
90-day mail service non-preferred brand-name
50% ( $250 max 3 )
30-day specialty CVS exclusive generic and preferred brand-name
50% ( $400 max 3 )
30-day specialty CVS exclusive non-preferred brand-name
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. 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.
11
2023 GEHA Medicare benefits
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