2023 GEHA Medicare Benefits Guide

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

$0

Professional surgical services; inpatient and outpatient Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year

$5

Vision coverage; eye exams 3

Balance after GEHA pays $22 per visit

Preventive dental; 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 3

30-day retail generic

20% ( $150 max 3, 4 )

30-day retail preferred brand-name

35% ( $200 max 3 , 4 )

30-day retail non-preferred brand-name

$15

90-day mail service generic

15% ( $350 max 4 )

90-day mail service preferred brand-name

30% ( $500 max 4 )

90-day mail service non-preferred brand-name

15% ( $150 max 4 )

30-day specialty CVS exclusive generic and preferred brand-name

30% ( $200 max 4 )

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 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.

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2023 GEHA Medicare benefits

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