High medical 2023
Lower overall medical and prescription costs
Highlights:
- Comprehensive brand-name and specialty prescription coverage
- NEW! $1,000 Medicare Part B premium reimbursement
- Low copays for doctor visits
- $2,500 hearing aid benefit
How this plan pays you back:
- Adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health Rewards
2023 High rates
| Self Only | Self Plus One | Self and Family | |
|---|---|---|---|
| Biweekly — employed | $105.74 | $243.49 | $304.39 |
| Monthly — retired | $229.10 | $527.56 | $659.52 |
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.
Costs (in-network)
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, check the GEHA Plan Brochure.| What you pay | |
|---|---|
| Unlimited telehealth visits, including mental health, with MDLIVE | $0 |
| Preventive care; adult routine screenings | $0 |
| Well-child visit; up to age 22 | $0 |
| Maternity; routine care | $0 |
| Maternity; inpatient care | $0 |
| Outpatient accidental injury, including ER (within 72 hours) | $0 |
| Outpatient lab services | $0 |
| Vision coverage; eye exams1 | $5 |
| MinuteClinic (where available) | $10 |
| Primary physician office visit | $20 |
| Mental health office visit | $20 |
| Specialist care office visit | $20 |
| Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year | $20 |
| Urgent care facility | $35 |
| ER visit; medical emergency | 10%2 |
| Hospital care; outpatient | 10%2 |
| Professional surgical services | 10%2 |
| X-ray and other diagnostic services | 10%2 |
| Acupuncture; up to 20 treatments per year | 10%2 |
| Hospital care; inpatient | $100 per admission plus 10% |
| Preventive dental care, twice yearly | Balance after GEHA pays $22 per visit |
2Calendar year deductible applies.
Deductible and out-of-pocket max (in-network)
| 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 medical plan. Members with Medicare A & B primary have even lower out-of-pocket costs for preferred and non-preferred brand-name prescriptions.
For added convenience and management of medications, your GEHA prescription benefits include access to presorted multi-dose packets. Presorted packets can be delivered to your home or, if available, picked up at a retail location.
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.
| What you pay in-network | |
|---|---|
| 30-day retail generic | $10‡ |
| 30-day retail preferred brand-name | 25% ($150 max)‡¤ |
| 30-day retail non-preferred brand-name | 40% ($200 max)‡¤ |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 25% ($350 max)¤ |
| 90-day mail service non-preferred brand-name | 40% ($500 max)¤ |
| 30-day specialty CVS exclusive generic and preferred brand-name | 25% ($150 max)¤ |
| 30-day specialty CVS exclusive non-preferred brand-name | 40% ($200 max)¤ |
‡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.
Highlights that are special to High
Medicare + GEHA
2023 Medical Benefits Guide
Ready to enroll?
Let's explain the process.