Medicare and GEHA

If you are age 65 or older, or otherwise entitled to Medicare, GEHA can offer additional protection from the high costs of health care. GEHA coverage can reimburse you for coinsurance and deductibles and other costs, including routine dental work and prescription drugs, not covered by Medicare. When you are enrolled in GEHA's High Option or Standard Option plan and Medicare Part A & B is your primary payer, GEHA will pay, up to the plan allowance, for routine physicals and checkups. In addition, if you have Medicare Part A & Part B primary, GEHA waives the calendar year deductible and copayments on hospital and physician services with both High Option and Standard Option even when you receive those services overseas. You pay a reduced copayment and coinsurance on prescription drugs with GEHA High Option.

For a quick view of GEHA benefits when you have Medicare A & B primary, click here to see the Medicare Member Benefits.

GEHA has prepared a free brochure to help current and future retirees understand how GEHA can supplement their Medicare coverage; to read this brochure, click on GEHA with Medicare.

Medicare includes three parts:

  • Part A is hospital insurance that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care. Most people do not have to pay premiums for Part A, but there are deductibles and coinsurance amounts.
  • Part B is a voluntary medical insurance program that pays a portion of doctors' services, outpatient hospital care, durable medical equipment and many services not covered by Part A. It has premiums, deductibles and coinsurance you must pay.|
  • Part D, the new Medicare prescription drug coverage, began January 1, 2006. Medicare prescription drug coverage is voluntary; to get this coverage, you must join a Medicare drug plan.

    If you do not join a Medicare prescription drug plan when you are first eligible, you will pay a penalty unless you have creditable coverage that is at least as good as Medicare prescription drug coverage.

    GEHA's prescription drug coverage is, on average, better than the standard Medicare prescription drug coverage. So, as long as you keep your GEHA health plan, you do not have to join a Medicare drug plan now and will not have to pay a penalty for Medicare prescription drug coverage if you decide to join a plan later.

When you have GEHA and Medicare, most of your claims can be filed electronically by GEHA Express. For information on electronic claims filing, call GEHA Express at 800.282.4342.

  • If Medicare is your primary insurance and you have not enrolled in GEHA Express, you should first submit your claims to Medicare. After Medicare has paid its benefits, they will send you a Medicare Summary Notice (MSN). Send the MSN along with copies of all bills to GEHA for processing. When Medicare is primary, there is no GEHA precertification requirement for hospital stays. However, if your Medicare benefits are exhausted prior to a hospitalization, GEHA precertification is required for the stay; failure to precertify would result in a $500 penalty.
  • If GEHA is your primary insurance, submit the bills to the GEHA claim office first. GEHA will process your claim and send you an Explanation of Benefits (EOB). You should then send the EOB with copies of the bills to Medicare.

If you are unsure of your primary insurance, or need more information on how GEHA coverage complements Medicare coverage, please call GEHA at 800.821.6136.