Works best for Medicare & prescription coverage.
High Option 2021
Comprehensive brand-name and specialty prescription coverage.
Works best with Medicare and includes a $600 Medicare Part B premium reimbursement.
Why you might like High Option:
- Low copays for doctor visits ($20 primary and specialist).
- $600 Medicare Part B premium reimbursement. (For more, visit Medicare reimbursement account.)
- $2,500 hearing aid benefit.
- Low cost-share for a variety of inpatient and outpatient services (10% coinsurance).
2021 ratesThese 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.
|Self Only||Self Plus One||Self and Family|
|Postal biweekly – Category 1||$104.78||$244.74||$306.32|
|Postal biweekly – Category 2||$94.72||$223.18||$282.90|
|Retirees monthly GEHA Medicare information
Plan of choice for Medicare enrollees
The combination of a $600 reimbursement for Medicare Part B premiums with a cost-share waiver, makes the High Option the plan of choice for Medicare enrollees.MEDICARE + GEHA
Low copays for office visits
In-network doctor visit copays are an affordable $20.
Low copays for generic prescriptions
You can get 30-day supplies of generic drugs for just $10.
Coverage for specialty drugs
Limit your out-of-pocket costs for specialty prescriptions and preferred brand-name medicines.
Costs for services in 2021
The table below summarizes your in-network cost for medical benefits with GEHA High Option. 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 the GEHA Plan Brochure.
|What you pay in-network|
|Unlimited telehealth visits with MDLIVE||$0|
|Preventive care; adult routine screenings||$0|
|Well-child visit; up to age 22||$0|
|Maternity; routine preventive care||$0|
|MinuteClinic (where available)||$10|
|Primary physician office visit||$20|
|Specialist care; office visit||$20|
|Emergency care; accidental (must be within 72 hours)||$0|
|Emergency care; medical||10%1|
|Hospital care; inpatient||$100 per admission plus 10%|
|Hospital care; inpatient maternity||$0|
|Hospital care; outpatient||10%1|
|Professional surgical services||10%1|
|Lab Card services||$0|
|Lab services (non-Lab Card)||10%|
|Other diagnostic services||10%1|
|Chiropractic care; up to 20 visits per year (spinal manipulation therapy)||Balance after GEHA pays $20 per visit|
|Chiropractic X-rays||Balance after GEHA pays $25 per year|
|Preventive dental care, twice yearly||Balance after GEHA pays $22 per visit|
|Acupuncture; up to 20 treatments per year||10%1|
1Calendar year deductible applies.
Yearly deductible & out-of-pocket max
|Self Only||Self Plus One||Self and Family|
|Yearly deductible (what you pay in-network)||$350||$700||$700|
|Out-of-pocket max (what you pay in-network)||$5,000||$10,000||$10,000|
The table below summarizes your cost for prescription drugs with GEHA’s High Option. Members with Medicare A & B primary have even lower out-of-pocket costs for preferred and non-preferred brand-name prescriptions.
For complete benefit information, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.
To find a drug cost based on your benefit plan and prescription dosage, check your drug costs.
Retail pharmacy – 30-day supply
|What you pay in-network||What you pay out-of-network#|
|Preferred brand-name||25% ($150 max)‡¤||25% ($150 max)‡¤|
|Non-preferred brand-name||40% ($200 max)‡¤||40% ($200 max)‡¤|
Mail service pharmacy – 90-day supply
|What you pay in-network||What you pay out of-network|
|Preferred brand-name||25% ($350 max)¤||No benefit|
|Non-preferred brand-name||40% ($500 max)¤||No benefit|
‡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.
¤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.
#Reimbursement will be based on GEHA’s costs had you used a participating pharmacy. You must submit original drug receipts.