High medical 2024
The dependable plan for people who need maximum coverage
Highlights:
- Low copays for doctor visits
- Comprehensive brand-name and specialty prescription coverage
- Waived coinsurance and copays for Medicare enrollees, excluding prescription benefits
- $1,000 Medicare Part B premium reimbursement
- $2,500 hearing aid benefit and other additional discounts
- Vision coverage with $5 annual eye exam from EyeMed®1
- Mental health benefit, including telehealth, from MDLIVE
Announcing GEHA Medicare Advantage Plans
New for 2024: GEHA is partnering with UnitedHealthcare to offer Medicare Advantage Plans to bring choice and value to our members through new plan options. Enjoy all the benefits of your original Medicare plan (Parts A and B), with prescription drug coverage (Part D) and additional benefits and features for no additional premium. Once you are enrolled in GHEA's High medical plan with Medicare Parts A&B primary, you qualify for the GEHA High Medicare Advantage Plan, a UnitedHealthcare® Group Medicare Advantage (PPO) plan.
Learn more about the GEHA High Medicare Advantage Plan
1These benefits are neither offered nor guaranteed under contract with the FEHB Program but are made available to all Enrollees who become members of the GEHA High plan and their eligible family members.
2024 High rates
| Pay frequency | Self Only | Self Plus One | Self and Family |
|---|---|---|---|
| Biweekly — employed | $108.65 | $249.67 | $306.26 |
| Monthly — retired | $235.41 | $540.95 | $663.56 |
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.| Medical benefit | 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; preventive prenatal and postnatal office visits | $0 |
| Maternity; childbirth/delivery professional services | $0 |
| Maternity; childbirth/delivery facility services | $0 |
| Outpatient accidental injury, including ER (within 72 hours) | $0 |
| Outpatient lab services | $0 |
| Vision coverage; eye exams1 | $5 |
| MinuteClinic visit (where available) | $10 |
| Primary care 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 visit | $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 visits 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 maximum (in-network)
| Term | Self Only | Self Plus One | Self and Family |
|---|---|---|---|
| Yearly deductible (what you pay in-network) | $350 | $700 | $700 |
| Out-of-pocket maximum (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.
| Prescription benefit | 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
