2023 GEHA Medicare Benefits Guide

Medical benefits with Medicare A & B primary in-network 1

You pay

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Vision coverage; eye exams 2 Primary physician office visit Mental health office visit MinuteClinic ® where available Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year Acupuncture; up to 20 treatments per year

$0

$10

$30

Specialist care office visit

$50

Urgent care facility

ER visit Hospital care; inpatient and outpatient X-rays and other diagnostic services Lab services Outpatient professional surgical services

25% 3

$250

Inpatient professional surgical services

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 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. 3 Calendar year deductible applies.

Prescription benefits in-network 1,2,3

You pay

$4

30-day retail generic

50% ( $500 max)

30-day retail preferred brand-name

100%

30-day retail non-preferred brand-name

50% ( $500 max)

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

100%

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 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

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2023 GEHA Medicare benefits

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