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Charlotte  
#1 Posted : Saturday, September 11, 2010 11:04:44 AM(UTC)
suttercare

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I am thinking of joining GEHA this open season. There does not seem to be much difference in the high option and the standard plan. But the cost difference is huge! My husband has medicare, take 5 prescriptions (all generic) I only (so far) see one Doctor a  few times a year and have only one prescription(generic) . I just am concerned that I am missing something about the standard plan, because it cost so much less. Anyone have the standard plan and why would you keep it?
Robert Rapp  
#2 Posted : Sunday, September 12, 2010 9:59:55 PM(UTC)
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I switched to GEHA standard last year after being with Mail Handlers many years.  MH rates syrocketed, so I reluctantly switched.  So far GEHA has been excellent. I have 6 Rx's and have a Dr. appt every couple of months or so, and I have not had one issue yet.  Knock on wood.  I didn't compare standard to high options, so I can't offer any advice there.
Retiree711  
#3 Posted : Sunday, September 12, 2010 10:08:33 PM(UTC)

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I had mail-handlers and switched to GEHA  standard few years ago-  so far no complaints--  many doctors and health care facilities in the plan - and the premiums are low compared to the others -
Terry  
#4 Posted : Sunday, September 12, 2010 11:14:31 PM(UTC)
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I have NALC after switching from BC/BS several years ago.  So far it has been excellent with no problems.  Any lab work I need is free to me when using the perferred lab.  I think with all the changes coming up this year we will all have to look real close at the plans and costs when they come out in Nov.  What I am hearing about private health insurance around here is that the costs are skyrocketing and whats being covered is dropping all thanks to Obamacare.  I know I will spend more time this year looking over all the plans.
martyb  
#5 Posted : Monday, September 13, 2010 4:53:34 AM(UTC)

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I'm going to take a hard look at GEHA this open season as well.  I had them about 25 years ago (yep, I've been around that long) and was perfectly happy, but for some reason I don't recall-maybe related to being a single dad with 2 kids & going to an HMS for awhile....I decided to leave GEHA.  Now...I've been on BCBS for a loooooong time, but the premiums are just getting out of hand, plus.....all the kids are gone & it's just me & the wifey.  So...gonna look into maybe saving a couple bucks.  I retire in 2 yrs, and so I guess I'll re-visit the whole thing again at that time.
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Sunshine4me  
#6 Posted : Wednesday, September 15, 2010 5:29:20 AM(UTC)

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Something to consider is GEHA's high deductible health savings account (HSA).  This was the first year it was offered and I've been VERY pleased with it.  It's primarily for those in good health.  Deductible is $3K.  A couple of advantages is that the HSA doesn't expire after a year (FSA's do) so can be carried over and preventive test are covered 100%.  Although OBAMA Care has reduced the tax benefits starting next year so FSA and HSA's don't include over the counter medications.  It takes some patience to initially set up the HSA, but it's worth it.  Definitely worth checking into. 
edalder  
#7 Posted : Wednesday, September 15, 2010 12:00:12 PM(UTC)

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The main thing with GEHA, if you are not yet of Medicare age, is to be certain that your preferred physicians are part of their network. Going out of network is very expensive with GEHA standard unless you have Medicare Part B.

GEHA's coverage may be adequate in metropolitan areas, but double-check whether your doctors, etc., are in the network before switching to avoid unpleasant surprises. If you live in a more rural area, you may find that your choice of physicians is somewhat limited.

Kivi
Retiree711  
#8 Posted : Wednesday, September 15, 2010 9:31:40 PM(UTC)

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Before I switched to GEHA I checked to see what doctors and health care facilities were in the network and saw that all my doctors were in , but I live in a metro area  so the rural factor could be limited
cherie  
#9 Posted : Saturday, September 18, 2010 7:30:45 PM(UTC)

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I've had GEHA for many years and have always been happy with it.  At first I signed up for High Option because that's what most people did back then.  When I retired almost 10 years ago, I switched to Low Option and have never been sorry.  My husband is on Medicare as well and GEHA pays everything that Medicare doesn't.  I have a small deductable and have been very fortunate with small co-pays.  My only disappointment is that the Low Option rates are rising more frequently than they used to.
Charlotte  
#10 Posted : Sunday, September 19, 2010 4:54:53 AM(UTC)
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Your reply has helped me decide to join GEHA. Thanks for taking the time to write. 
daves  
#11 Posted : Sunday, September 19, 2010 11:34:01 AM(UTC)

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Happy with the GEHA standard plan.  The only downside is the closest hospital (15 miles) (excellent rating) is not part of the network.  The 2nd closest hospital (25 miles)(not a very good reputation) is part of the network.  So for in-hospital procedures we have to weigh quality of care versus cost.  Rural area so those two hospitals are the only two choices unless we want a 2 hour drive to a regional medical center.
OUtside  
#12 Posted : Monday, September 20, 2010 4:26:46 AM(UTC)

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I think the positive side of GEHA Standard with Medicare has been pretty well made. And I would not want to argue with it, I think there is a good chance to save fehb premium expense, in this way.

However, at risk of calling up the snl character by Rachel Dratch who always saw the dark side of things, someone ought to mention directly there is a possible downside to taking the lesser option, one particular in this case is the requirement to pay 50% co-pays for brand name drugs up to $200 per month per prescription. It seems to me anyone taking this route ought to be very clear in their own mind the risk they are agreeing to. For example, suppose the doctor says one day, well, we have a big problem on our hands but fortunately there are several new medications we can use, although these new medications are very expensive. You have good insurance, right?…---(but it turns out you will have second-rate insurance for brand name drugs).

Moreover, as Medicare Part B has essentially no prescription drug benefit, I don’t see the connection between having Part B with fehb medical co-pays waived and accepting second-rate brand name prescription drug benefits from fehb. Actually, the connection is potentially a negative one; for example, if you have abundant fehb medical co-pays waived, you probably have challenging health issues with, guess what, that much greater risk of needing expensive brand name drugs.

Finally, if you carried the more expensive fehb option with the first rate prescription drug benefit when you were young and healthy, is it timely now in your golden years and more susceptible to illness, including serious illness, to switch gears to an fehb option with a second-rate prescription drug benefit?

I wonder.

restonham  
#13 Posted : Wednesday, September 22, 2010 11:54:56 PM(UTC)

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Outside has a great point.  I have also wondered why I am now thinking of going to a standard plan after years and years of high coverage.   It's a very individual decision and not an easy one to make.  Since I have no idea what will happen once nationalized medicine begins, I will just wait until I am forced to make a decision.   I have NALC (which only has one level) and am very happy with it.  I have had GEHA in the past and that was an excellent plan also. 
Charlotte  
#14 Posted : Thursday, September 23, 2010 5:29:16 AM(UTC)
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Outsides reply has changed my mind about taking the cheaper plan. The very day I got his post, my husband was given a prescription for Plavix. The cost with the cheaper GEHA would be $85.00 and the high option $40.00  for   a 30 day supply.  The mail order option for the higher cost plan is an even better bargain. 
OUtside  
#15 Posted : Monday, September 27, 2010 5:48:36 AM(UTC)

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This GEHA web link may be of interest. It says many federal retirees with Standard also enroll in an inexpensive Medicare Part D plan (prescription drugs). This could be worth exploring but would require, I assume, selecting a suitable Part D plan from among several plans and then learning how coordination would be done between Medicare and GEHA for subscriber’s specific Rx benefits. Hopefully, the result would be overall savings vs. taking the higher GEHA option, at least that is what appears to be implied, ISTM.

Also implied if you think about it, ISTM, is that the Standard brand name prescription benefit on its own is not very much to write home about, especially for subscribers in their golden years.

http://www.geha.com/geha_health_plans/standard_option_summary.html

cherie  
#16 Posted : Tuesday, September 28, 2010 8:50:27 AM(UTC)

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Several factors went into my decision to switch to Standard Option when I retired.  First there was the huge difference in premium that I would be paying as a retiree compared to what I paid as an employee.  USPS employees pay a lower rate than other government employees, yet when they retire, they pay the same as other retirees.  That’s a double bump.  I’m not complaining about equal treatment, just commenting that when you’ve had a good deal and lose it, it is noticeable.  Second, I did not have a history of using insurance very often so decided to try Standard for a year and see how I fared.  I kept a spreadsheet and definitely came out money ahead, so I stayed with it another year and then another year…..it’s been almost 10 years now.  That brings me to the third point.  Every year, I can reevaluate.  I might get stuck with some expenses the first year if my health goes south, but then there’s open season and a chance to kick it up a notch.   If it weren’t for open season---if we had to pick a plan upon retirement and stick with it, I doubt that I would have gone with the Standard, but as long as we have the opportunity to change, I’ll gamble on that first bad year that hopefully won’t come.  It is a very personal decision, right up there with investment decisions:  How much risk are we willing to take and what price are we willing to pay to reduce risk?  This forum is good.  While it is a personal decision, getting input from others with a different perspective is helpful. OUtsides point concerning the Rx issue never occurred to me and excellent point it is.

greywolf  
#17 Posted : Sunday, October 24, 2010 3:21:43 AM(UTC)

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edalder wrote:
The main thing with GEHA, if you are not yet of Medicare age, is to be certain that your preferred physicians are part of their network. Going out of network is very expensive with GEHA standard unless you have Medicare Part B.

GEHA's coverage may be adequate in metropolitan areas, but double-check whether your doctors, etc., are in the network before switching to avoid unpleasant surprises. If you live in a more rural area, you may find that your choice of physicians is somewhat limited.
 
I completely agree with this comment.  I live in a small town, and used to have GEHA, but I found out the hard way that going out of network for medical care (which I basically had to do) cost me a fortune.  And even then, GEHA disputed every claim I submitted, making for a major hassle.  I switched to BCBS and will not go back to GEHA.
golfer  
#18 Posted : Saturday, September 03, 2011 10:27:53 AM(UTC)

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Daves, I'm suggesting that GEHA isn't the best, regardless.  Doesn't pay our doctrors (even if in plan) and won't tell us why.  They're way messed up.  Wondering if they're financially solvent .........
getting close  
#19 Posted : Saturday, September 03, 2011 9:14:43 PM(UTC)

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golfer, that's not my experience. I've had a number of routine claims and they've been paid just as before.    

It may have something to do with your PPO network. Has it changed? In the Washington, D.C. area, GEHA recently switched to the UnitedHealthcare PPO network. According to the GEHA web site, it acknowledged that this had slowed the processing of claims but they said they thought this would improve. getting close2011-09-04 05:21:18
edalder  
#20 Posted : Tuesday, September 06, 2011 9:31:22 PM(UTC)

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I was OK with GEHA standard up until a few years ago. Then the Plan switched provider networks in our area. My spouse has a number of medical issues and only one of the five specialists that he regularly sees was in the new network. He also would have needed to find a new primary care physician. While he does have Medicare Part A, I am still employed. Therefore, Medicare Part B for him currently would not be cost effective for us. Consequently, he cannot utilize the option of going out of network for care on the basis that he has Medicare.

Well, he was not about to "educate" four new specialists, etc. That pretty much ended our relationship with GEHA.

We went with NALC, which uses the Cigna network in our area. That has worked out for us. NALC was less than BC-BS but more than GEHA in terms of the premium.

Fortunately, he only uses one brand name drug (Crestor), but NALC does pick up a higher percentage of the cost of such drugs than GEHA standard. The local CVS is three blocks away, but you do need to educate yourself about NALC policies regarding maintenance RX.

Ultimately, you have to sit down and do your own analysis of which plan works best for you. There is no one size fits all answer here.


Kivi
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