suggested for you

Works best for Medicare & prescription coverage.

High Option 2021

View the 2020 High Option plan

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

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

Key plan features