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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

To read today's top news stories on federal employee pay, benefits, retirement, job rights and other workplace issues visit FederalDaily.com.

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ForwardGoing  
#1 Posted : Monday, March 29, 2021 1:42:57 PM(UTC)
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Hi,

I'm trying to get some advice on health insurance. I am a Federal Employee and currently have Aetna HDHP (224). I was browsing through the different plans and came accross GEHA HDHP (341).

Here is a link to the full break down comparison from OPM: https://www.opm.gov/healthcare-i...rand%5BCoinsurance%5D=60

This plan seems to be better in every way compared to my current plan.

Aetna HDHP (224) ----- GEHA HDHP (341)

Premiums: $121.20 vs $61.37
Deductible: $1,800.00 vs $1,500.00
Out-of-Pocket Maximum: $6,900.00 vs $5,000.00
CoInsurance Split Rate: 15% vs 5%
HSA Contribution: $63 vs $75

The two major difference I can see are:

1. The Prescription Drugs costs. Aetna has the normal $10 to $300 max rates while GEHA has a flat 25% rate.
2. There are some weird stipulations in GEHA's Summary of Benefits chart here: https://www.geha.com/~/media93/p...enefits-and-coverage.pdf. A lot of it has to do with them wording everything to say it must be "pre-authorized" vs Aetna's Summary of Benefits chart here not having that wording here: https://www.aetnafeds.com/pdf/2021/2021SBC_HDHP.pdf


For #1 I ran some numbers and even though GEHA will cost me more monthly in drug costs I will still be paying less from the lower premiums.

Also, GEHA in my state uses Aetna Signature Administrators so I believe I will get to keep all my same doctors if I switch (let me know if this is wrong). https://www.geha.com/~/media/Fil...s/other/GEHAnetworks.pdf

My question is can anyone tell me why GEHA is so much less expensive while offering so much better rates compared to my current plan? Is there something I'm missing? Is the "pre-authorized" statements a big deal that will get my health claims denied more often than from my current plan? Any help/advice would be appreciated.

Edited by user Monday, March 29, 2021 1:46:07 PM(UTC)  | Reason: Not specified

10years2retire  
#2 Posted : Monday, March 29, 2021 7:07:42 PM(UTC)
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Keep in mind that Aetna was bought by CVS 2 years ago, and higher rates are what apparently happens when a drug store owns a healthcare company.

GEHA is basically a small town insurance company that contracts out everything to provide benefits to it's members. I switched my HDHP from Aetna to GEHA when the price jumped last year and it has been nothing but problems getting the HSA setup. Evidently GEHA uses a contracted bank called HSA Bank to operate the HSA part, but never sent me the account opening form to send to HSA Bank to open the special GEHA linked HSA account.

All the contracted customer support that answers the phone number can tell you to do, is to go to the www.hsabank.com website and open an account. But by doing so you are opening a retail account that will be charged $2.50 a month in maintenance fees, when it is supposed to be free. The contracted support does not have the HSA opening form, and they might refer you to the membership dept if you open a retail account, and they will fund it, but once again you will pay the monthly fee.

I gave up going back and forth between GEHA and HSA Bank trying to find a solution. Still waiting to see if the letter I wrote to GEHA a month ago will have any response. My next letter will go to OPM. But all in all the $35 annual fee is still cheaper than the $700 increase Aetna was trying to charge me.

In the next open season I will be looking to see if there is another company besides Aetna or GEHA thats offering a HDHP at a reasonable monthly price.

Edited by user Monday, March 29, 2021 7:10:32 PM(UTC)  | Reason: Not specified

ForwardGoing  
#3 Posted : Tuesday, March 30, 2021 9:43:53 AM(UTC)
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Have you had any other issues besides your HSA bank monthly fee? Is your coverage just as good as when you were with Aetna, any claims being denied? Is there any extra steps or calls that need to me made for their pre-approval process or does the doctor's office do that for you? When you switched from Aetna to GEHA did you get to keep all your old doctors?

Thanks for your post.
10years2retire  
#4 Posted : Tuesday, March 30, 2021 1:51:16 PM(UTC)
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Nope, no issues besides it takes them about 30 days to send the EOB with what you need to pay the doctor or lab. Also if you take the GEHA Dental then be ready to fork over the whole amount for a crown that needs to be done on a tooth that has had one done within the past 5 years ( happened to me), for which the HSA is quite a help in paying da bill.

I have not hit my $1500 medical deductible yet, so I don't know how they payout when they have to cover it all

Amazingly, the morning after I posted my HSA horror story on here, someone from GEHA responded to my letter with a magic form to open a linked GEHA HSA account at HSA Bank --- must be a coincidence!
teeeeej  
#5 Posted : Tuesday, March 30, 2021 1:58:49 PM(UTC)
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Originally Posted by: 10years2retire Go to Quoted Post
Keep in mind that Aetna was bought by CVS 2 years ago, and higher rates are what apparently happens when a drug store owns a healthcare company.

GEHA is basically a small town insurance company that contracts out everything to provide benefits to it's members. I switched my HDHP from Aetna to GEHA when the price jumped last year and it has been nothing but problems getting the HSA setup. Evidently GEHA uses a contracted bank called HSA Bank to operate the HSA part, but never sent me the account opening form to send to HSA Bank to open the special GEHA linked HSA account.

All the contracted customer support that answers the phone number can tell you to do, is to go to the www.hsabank.com website and open an account. But by doing so you are opening a retail account that will be charged $2.50 a month in maintenance fees, when it is supposed to be free. The contracted support does not have the HSA opening form, and they might refer you to the membership dept if you open a retail account, and they will fund it, but once again you will pay the monthly fee.

I gave up going back and forth between GEHA and HSA Bank trying to find a solution. Still waiting to see if the letter I wrote to GEHA a month ago will have any response. My next letter will go to OPM. But all in all the $35 annual fee is still cheaper than the $700 increase Aetna was trying to charge me.

In the next open season I will be looking to see if there is another company besides Aetna or GEHA thats offering a HDHP at a reasonable monthly price.


MHBP is a reasonably priced HDHP.
GWPDA  
#6 Posted : Wednesday, March 31, 2021 7:03:13 AM(UTC)
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I've found GEHA to be very responsive and very reasonably priced. My prescriptions, with one exception are all mail order and priced accordingly. The most difficulty I've had was in getting CVS to grasp that enrollment in the Government Employees Health Association is NOT the same as being enrolled in a government funded health insurance policy - a problem I solved by moving that one prescription to Safeway.
Sante123  
#7 Posted : Friday, April 16, 2021 8:39:35 AM(UTC)
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Originally Posted by: 10years2retire Go to Quoted Post
Nope, no issues besides it takes them about 30 days to send the EOB with what you need to pay the doctor or lab. Also if you take the GEHA Dental then be ready to fork over the whole amount for a crown that needs to be done on a tooth that has had one done within the past 5 years ( happened to me), for which the HSA is quite a help in paying da bill.


Actually, in my experience with GEHA (five years with their medical plan and many more with the dental), claims processing has been very speedy since their systems upgrade of 5-6 years ago. In fact, all but the most complex claims get processed to completion within 24 hours of receipt from the provider. And why would you wait to have the EOB sent to you when it’s available digitally for viewing and download on the GEHA member website a day or so after a claim is adjudicated?

I’m also curious why you would single out GEHA Dental re: coverage limitations for crowns previously placed less than 60 months in the past. This rule is pretty standard for FEDVIP plans. A look at the 2021 FEDVIP brochures reveals that United Healthcare, Blue Cross, Aetna, MetLife and Delta Dental all have the same language in their plans.

Edited by user Friday, April 16, 2021 8:44:19 AM(UTC)  | Reason: Not specified

Sante123  
#8 Posted : Friday, April 16, 2021 9:11:21 AM(UTC)
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Originally Posted by: ForwardGoing Go to Quoted Post
My question is can anyone tell me why GEHA is so much less expensive while offering so much better rates compared to my current plan? Is there something I'm missing? Is the "pre-authorized" statements a big deal that will get my health claims denied more often than from my current plan? Any help/advice would be appreciated.


If you look under the FEHB subheading for the popular thread entitled “ Open Season FEHB - GEHA”, there is a good exchange concerning how GEHA operates. The thread is about the GEHA Standard plan for the most part, but many of the issues addressed will have relevance for the HDHP plan as well. Good luck in your search.
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