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 rates
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.| Self Only | Self Plus One | Self and Family | |
|---|---|---|---|
| Non-Postal biweekly | $108.14 | $251.93 | $314.13 |
| 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 |
$234.31 | $545.85 | $680.61 |
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 |
| Urgent care | $35 |
| 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 |
Prescription benefits
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# | |
|---|---|---|
| Generic | $10‡ | $10‡ |
| 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 | |
|---|---|---|
| Generic | $20 | No benefit |
| 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.
