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Health insurers are threatening not to cover some patients’ ER bills

Plans like United Healthcare say it’s necessary to contain health care costs. Experts say it’s the wrong approach.

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People stand outside the emergency room at Riverside Community Hospital in Riverside, California.

United Healthcare, the largest insurer in the US, recently announced a new policy it said would help hold down health care costs: It would review claims for emergency department care , opening up the possibility that the company might deny coverage if a patient’s medical needs were not actually an emergency.

After outcry from doctors and patients, the insurer said it would delay implementation until the Covid-19 pandemic has passed — but it still plans to institute the policy eventually.

United Healthcare framed the maneuver as a way to contain costs, as the New York Times reported . But there are problems with that idea, according to the half dozen health policy experts I spoke to. It’s not clear emergency room misuse is actually a rampant problem. And even if some patients do unnecessarily visit the ER, United’s new policy risks discouraging people from seeking necessary care without any guarantee that it will actually bring down costs.

“Too blunt and the wrong problem” is how Tom Tsai, a health policy researcher at Harvard University and a surgeon at Brigham and Women’s Hospital, succinctly put it to me.

“We shouldn’t reduce emergency department visits because we expect to save money,” Laura Burke, a physician at Beth Israel Deaconess Medical Center in Boston who has studied emergency room use, told me. “Because there is no evidence that’ll actually happen.”

The problem is not that patients overuse or misuse the emergency room, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. Emergency department visits have actually been stable for years and, after a drop during the Covid-19 pandemic, have not yet recovered to previous levels.

If anything, the problem is the prices that hospitals charge for ER services, experts said. Those have been rising in recent years. United may be trying to send a warning on prices to providers with its new policy — “a shot across the bow,” as Hempstead put it — but in doing so, patients are being put at risk of facing huge medical bills they may struggle to pay.

“It’s not fair to patients,” she said. “It puts the patients in the middle.”

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There isn’t good evidence that people overuse the ER or that cutting ER visits would save money

The first problem, according to the available research and the experts I talked to, is that reducing ER visits may not actually reduce health care spending.

The ER utilization issue is sometimes framed in the terms that United used: A hospital emergency room is a more expensive place to receive care than a primary care doctor or another outpatient setting. So if people go to the ER unnecessarily, that drives up costs for the health insurer, which then passes along those costs to everybody in the form of higher premiums. The implication is if we directed people to appropriate settings for treatment — primary care being an obvious alternative — we’ll save money.

The theory looks to be half-right. A 2017 study , which sought to encourage uninsured Virginians to visit a primary care physician instead of the ER, found that there was a modest reduction in non-urgent visits to the emergency department with patients who received the study’s financial incentive.

However, the researchers wrote, “total costs did not decline because any savings from avoiding the emergency department were offset by increased outpatient utilization.”

A 2019 op-ed in JAMA , authored by three academics from Harvard and Mass General, reviewed the relevant literature on investing more money in primary care to cut costs elsewhere and reached largely the same conclusion.

Shifting care from the emergency room to outpatient settings may have real clinical benefits for patients — the evidence is robust that early medical interventions, in primary and specialist care, lead to better outcomes — but it won’t necessarily save money. People might get more outpatient care and, on top of that, hospitals will charge what they must to cover the cost of operating an emergency department.

“From a system perspective, there are not a lot of savings from reducing avoidable emergency department use,” Joel Cantor, a Rutgers University professor who has studied the issue, told me. “EDs have very fixed costs. They have to be open 24/7.”

So there might be some emergency room overuse happening, but it’s not actually clear how much. Patients already have strong incentives — in the form of high deductibles and other cost-sharing — to avoid the ER if they can.

“It’s an easy story to think of the ED as this extra waste in the health care system,” Tsai said. “Realistically, the ED is just an entry point. It’s become the lobby for the health care system.”

For starters, primary care doctors are often the ones who send their patients to the emergency room. Some number of those ER patients will end up admitted to the hospital for inpatient care. That is the system working as it should.

Instead, the problem can start before a patient ever steps into the ER. Cantor told me he views emergency service overuse as a symptom of other access issues. People who end up going to the ER for non-urgent care may not have a primary care doctor at all. Or they might not be able to find a specialist who will take their health plan. (This is a problem for Medicaid patients in particular.)

“The emergency room is maybe their only place to get timely specialist care,” he said. “The irresponsibility hypothesis is overblown.”

Moreover, a policy like United Healthcare’s puts the onus on patients to figure out whether they’re having an emergency. (The same objections were raised when Anthem announced it would institute a similar policy two years ago; that policy is currently tied up in litigation .)

Chest pain could be indigestion or a heart attack — most laypeople are not going to know which. While the health insurer said it would account for the symptoms that drove a patient to go to the ER in reviewing claims, the mere existence of such a policy may discourage people from seeking care. A recent study of what happens when people are moved into high-deductible health plans found that ER use did decline — but so did later admissions for serious health attacks.

“It puts patients in the position of having to judge whether or not they’re having an emergency,” Burke said, “and we know that is going to be potentially fraught with error.”

The problem is hospitals have been hiking their prices for emergency services

Every expert I spoke to was sympathetic to the goal of reducing health care costs. But considering the poor evidence that cutting ER use would actually achieve that goal, and the possibility that people would skip necessary care rather than risk being denied coverage, nobody seemed to think United Healthcare’s plan was the right approach.

In general, Americans don’t actually use more health care than people in other countries that spend less money collectively on health care than the US does. The difference is in the prices that US health insurers have to pay for health care services, versus insurers — public or private — in the rest of the world where medical prices are more directly regulated.

The pattern holds for emergency care specifically. A recent government report concluded that the rate of ER visits was stable from 2009 to 2018, the last year for which full data was available.

But costs to insurers have still been increasing — because the prices charged by hospitals keep going up.

“Estimates indicate that almost all spending growth for emergency room services reimbursed by commercial insurers in recent years has been driven by price increases, particularly for high-severity conditions, as opposed to utilization growth,” the authors of that federal report wrote.

Recent news reports have highlighted questionable ER billing practices on the part of hospitals. Kaiser Health News reported on HCA Healthcare, the largest for-profit hospital chain in the country, and its strategy of setting up more trauma centers and then charging enormous “activation” fees (as much as $50,000) to increase its revenue.

With that in mind, Hempstead said she interpreted United Healthcare’s move as a warning to providers: Keep jacking up prices and we’ll make your life difficult by vetting the claims.

But it is also putting patients in the middle of a long-running war between providers and insurers.

“It’s a price problem,” Tsai said. “We always keep dancing around the edges and trying to fiddle with utilization because it’s hard to fix the prices.”

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When Insurers Deny Emergency Department Claims for Non-Emergency Care

Refusal of Coverage for an ER Visit

If you've just cut your finger off in a table saw, it's pretty clear that the emergency room should be your next stop. But not all emergencies are quite that clear-cut. This article will explain what constitutes a medical emergency, and the rules that health plans are required to follow in terms of coverage for emergency care.

Emergency rooms are the most expensive places to receive medical treatment. So for non-emergency situations, insurers want their members to utilize other, lower-cost venues, including urgent care centers or a primary care provider's office.

When patients use non-ER facilities, it's less costly for the insurer, and that translates into lower overall healthcare cost—and lower insurance premiums—for everyone. But in the case of a life- or limb-threatening situation, an emergency room will likely be the only place that's properly equipped to handle certain situations.

The conundrum is that most people aren't trained in emergency medicine, so if in doubt about the severity of a medical situation, erring on the side of caution (i.e., going to the emergency room) generally seems like the most prudent solution.

Indeed, the "prudent layperson standard" has been adopted in most states, defining a medical emergency as a medical condition that a prudent layperson could reasonably expect to result in serious jeopardy to their health, bodily functions, or any body part, if medical treatment isn't received immediately.

In other words, you don't have to posses extensive medical knowledge or know what the actual diagnosis is in order for the situation to be accurately considered an emergency.

Insurers Suspend Controversial ER Claim Review Practices

For the most part, insurers cover trips to the emergency room under their emergency coverage rules. This includes out-of-network coverage , even if the health plan doesn't otherwise cover out-of-network care.

But Anthem caused controversy in 2017 with new rules in six states (Georgia, Indiana, Missouri, Ohio, New Hampshire, and Kentucky ) that shifted the cost of ER visits to the patient if a review of the claim and the patient's diagnosis (as opposed to symptoms) determines that the situation was not an emergency after all.

A patient profiled by Vox went to the emergency room in Kentucky with debilitating abdominal pain and fever. Her mother, a former nurse, had advised her to go to the emergency room, as her symptoms were associated with appendicitis , which is considered a medical emergency. But it turned out that she had ovarian cysts instead, something that was only pinpointed after medical care had been provided in the ER.

Anthem then sent her a bill for more than $12,000, saying that her claim had been denied because she had used the emergency room for non-emergency care. The patient appealed, noting that she had no way of knowing that her pain wasn't an emergency until the ER physicians diagnosed her. Eventually, after her second appeal (and after the patient discussed her story with Vox), Anthem paid the bill.

It's noteworthy that Modern Healthcare reported in 2018 that when patients appealed their emergency claims that Anthem had denied, the majority of those appeals were successful.

However, the American College of Emergency Physicians filed a lawsuit over Anthem's emergency claim rules. The suit was eventually withdrawn in 2022, after Blue Cross Blue Shield Healthcare Plan of Georgia agreed to discontinue the practice of reviewing emergency department claims to see if the ultimate diagnosis (rather than symptoms) constituted an emergency.

UnitedHealthcare generated headlines in 2021 with the announcement of a similar policy that was slated to take effect as of July 2021. But amid significant pushback from emergency physicians and consumer advocates, UnitedHealthcare quickly backpedaled, announcing just days later that they would delay the implementation of the new rules until after the end of the COVID pandemic.

Ultimately, UnitedHealthcare clarified in 2022 that they would not move forward with implementing the new ER claim review protocol.

ER Billing Headaches Now Less Common

Anthem and UnitedHealthcare generated plenty of headlines over their ERfclaims rules, and they were ultimately either suspended or not implemented. But surprise medical bills triggered by a trip to the ER were not new. Fortunately for consumers, those are much less common now than they used to be.

This is because the No Surprises Act prevents balance billing from out-of-network providers in emergency situations. This applies to both out-of-network emergency rooms as well as the medical providers who work in an emergency room.

For people enrolled in Medicaid, some states impose higher copays for non-emergency use of the emergency room (although in keeping with Medicaid rules, the copays are still nominal when compared with the cost of the care provided in the ER).

The nature of emergency care makes it difficult for patients to jump through insurance hoops that would otherwise be fairly straightforward. In non-emergency situations, people routinely call their insurance company to ask about prior authorization or check with a primary care doctor or nurse hotline to see what care is recommended. But in an emergency—or what appears to be an emergency, from the patient's perspective—those things may be overlooked.

And for the most part, that's the way it's supposed to be. If your spouse is having a stroke, you're not supposed to worry about calling your insurance company—you're supposed to call 911 or get to the ER as quickly as possible.

But when consumers hear stories about insurers denying ER bills because the insurer later deemed the situation a non-emergency, it's understandably worrying. The patient in the Vox article noted that after the experience she had with her ER bill and the Anthem claim denial, in the future she'll "go to primary care, and they’ll have to force [her] into an ambulance to go to the emergency room."

This is why it's important to understand that the scenarios that were making headlines in 2017 and 2018 have largely been reversed by the insurance companies, after significant legal pushback from physicians and consumer advocates.

Understand Your Policy Before It's an Emergency

The more you know about how your health insurance plan works, the better prepared you'll be for situations when you end up needing to use your coverage. So, the first step is to carefully read and understand your policy.

People tend to stick it in a drawer and forget about it until they need to use it, but there's no time for that in an emergency situation. So, at a time when you're not facing an imminent need for health care, sit down with your policy and make sure you understand:

  • The deductible and out-of-pocket costs on your plan, and any copay that applies to ER visits (note that some policies will waive the copay if you end up being admitted to the hospital via the ER, and the charges will instead apply to your deductible—these are the sort of things you'll want to understand ahead of time, so call your insurance company and ask questions if you're unsure how your plan works).
  • Whether your plan covers out-of-network care , and if so, whether there's a cap on your costs for out-of-network care. In addition, if there's more than one ER in your area, you'll want to determine which ones are in your plan's network and which are not, since that's not the sort of thing you want to be worrying about in an emergency situation. The No Surprises Act has eliminated surprise balance billing in emergency situations, but it's still less hassle to just use an in-network ER if it's just as convenient as an out-of-network ER.
  • Whether your plan has a rule that would result in a claim denial for non-emergency use of the ER. If so, familiarize yourself with your insurer's definition of emergency versus non-emergency. If the guidelines don't seem clear, call your insurer to discuss this with them, so that you can understand what's expected of you in terms of the type of facility you should utilize in various situations. (Again, the health plan rules that generated headlines several years ago have largely been suspended, but claims processing protocols still vary considerably from one insurer to another. Although the prudent layperson standard provides you with protections, it's important to note that if you use the ER for a situation that a prudent layperson wouldn't consider an emergency, your health plan might question your use of the ER.)
  • What your insurer's requirements are in terms of prior authorization for subsequent medical procedures that stem from an ER visit. Prior authorization cannot be required for emergency situations, but if you need additional follow-up care, you may need to get it authorized by your insurer ahead of time.

What Should You Do If You Get an Unexpected ER Bill?

If you get a larger-than-expected bill after a visit to the ER, reach out to your insurer and make sure you understand everything about the bill.

Is it a balance bill from an out-of-network ER? If so, the No Surprises Act should allow you to get it sorted out without having to pay out-of-network charges.

Or is it a claim denial because your insurer deemed your situation a non-emergency? If you've received a notice that your claim has been denied because your insurer has determined that your situation was not an emergency (and you believe that it was, indeed, an emergency situation or at least one in which a prudent layperson would consider it an emergency), you may find that the claim gets paid if you appeal : 

  • If your plan isn't grandfathered, the ACA guarantees you the right to an internal appeal process, and if the insurer still denies your claim, you also have access to an external review by an independent third party.
  • You can start by initiating the internal appeal process with your insurer, and also by reaching out to your state's insurance department to see if they have any guidance for you.
  • Keep track of what happens during the appeals process, including the names of people you speak with and any communications you receive from your insurer. You'll also want to keep the hospital in the loop, as they may need to submit additional information to the insurance company in order to demonstrate that your situation warranted a trip to the ER.
  • If the internal and external appeals are unsuccessful, you'll want to address the situation with the hospital. They may be willing to reduce their bill or set up a manageable payment plan. 

The Controversy Around Surprise ER Bills

The news of Anthem's new ER guidelines in Georgia, Indiana, Missouri, and Kentucky in 2017, and then in Ohio in 2018 (a planned expansion into New Hampshire was canceled), was met with an outcry from patients and consumer advocates.

The American College of Emergency Physicians pushed back with a video created to highlight the flaws in a system that essentially tasks patients with understanding what is and isn't an emergency, when some situations simply can't be assessed without running tests.

An analysis from JAMA Network indicated that if Anthem's policy were to be adopted by all commercial insurers, claims could potentially be denied for one in six emergency room visits.

UnitedHealthcare projected in 2021 that the implementation of their proposed ER claims rules (which were never implemented) would result in claim denials for about 10% of emergency room visits. Most visits would have still been covered, but that's still a significant number that would have been rejected.

Anthem noted that their approach is based on language that was already in their contracts and that the "prudent layperson" standard had always been used but was being enforced under the new rules (i.e., if a "prudent layperson" would consider it an emergency, then it's an emergency).

But clearly, both insurers' decisions were controversial, and they ultimately backed off from the new approach to processing ER claims. Patients, medical providers, and consumer advocates worried that patients could be faced with indecision (at a very inopportune time) about whether to seek care in the ER, resulting in potentially poorer health outcomes.

Anthem and UnitedHealthcare were focused on reining in the cost of health care—a task that virtually everyone agrees is necessary, but few agree on how to accomplish.

Although the solutions seem obvious when looked at from the perspective of a patient or consumer advocate, it's challenging to get all of the stakeholders on board. Consumers need to understand as much as they can about how their coverage works and what their appeal rights are if they find themselves with an unexpected bill after a visit to the ER.

Health plans are required to cover emergency room care even if it's out-of-network. And the "prudent layperson" rule protects patients in situations where the symptoms indicate an emergency, even if the ultimate diagnosis is a condition that isn't actually an emergency.

Some health plans have made waves in recent years with new claim-processing protocols that involve reviewing ER claims to see if the situation was truly an emergency. However, they have largely backed off on these protocols due to pushback from physicians and patient advocates. But a health plan can still reject an ER claim if a "prudent layperson" would not consider the symptoms to be an emergency (e.g. a runny nose).

A Word From Verywell

if you feel that you or a loved one is facing an emergency medical situation, the best course of action is still to head to the emergency room. It's unlikely that your insurer will dispute the claim based on a later decision that the situation was not an emergency. But if they do, you can appeal and have fairly good odds of winning your appeal.

The prudent layperson standard is useful to understand if you find yourself needing to appeal a claim that's being denied because the health plan is looking at the final diagnosis rather than the symptoms you were experiencing that caused you to go to the ER.

Cornell Law School, Legal Information Institute. § 438.114 Emergency and poststabilization services .

Vox. An ER visit, a $12,000 bill - and a health insurer that wouldn't pay .

Livingston, Shelby. Modern Healthcare. Anthem Overturned Most Appealed ER Claims It Denied Under Controversial Policy .

U.S. District Court for the Northern District of Georgia, Atlanta Division. American College of Emergency Physicians and The Medical Association of Georgia VS Blue Cross and Blue Shield of Georgia, Inc.; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and Anthem Insurance Companies, Inc.

American College of Emergency Physicians. Georgia Emergency Claims Review Program Discontinued by Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., and ACEP and MAG Withdraw Suit in Response . March 9, 2022.

American College of Emergency Physicians. ACEP Condemns UnitedHealthcare's New Policy to Retroactively Deny Emergency Care.

Abelson, Reed. NY Times. Outcry Forces UnitedHealthcare to Delay Plan to Deny Coverage for Some E.R. Visits.

Pifer, Rebecca. Health Care Dive. UnitedHealthcare permanently shelves controversial ER coverage changes following confusion . January 4, 2022.

Mortensen K. Copayments did not reduce medicaid enrollees' nonemergency use of emergency departments . Health Aff (Millwood) . 2010;29(9):1643-50. doi:10.1377/hlthaff.2009.0906

Kaiser Family Foundation. Surprise Medical Bills: New Protections for Consumers Take Effect in 2022 .

Healthcare Finance. Out-of-pocket costs rising even as patients transition to lower-cost care settings .

U.S. Department of Health and Human Services. Appealing health plan decisions .

American Medical Association. Physicians protest harmful Anthem emergency care coverage policy .

Chou SC, Gondi S, Baker O, Venkatesh AK, Schuur JD. Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses .  JAMA Netw Open . 2018;1(6):e183731. doi:10.1001/jamanetworkopen.2018.3731

Freeman, Liz/ Naples Daily News. Patients Could Be On the Hook for ER Bills as Insurer Moves to Deny Claims It Deems Unnecessary.

Anthem. Finding the right medical care when it's not an emergency .

By Louise Norris Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology.

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Comparing FEHB Plans to their Medicare Advantage (MA) Option

Posted on Friday, 24th November 2023 by Dennis Damp

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This article compares the Government Employees Health Association (GEHA) Standard Plan to their new MA Option. You will have to review the specific plan of interest to ensure it covers the services you need for the upcoming year.  

Open season closes December 11, we have less than two weeks to decide whether to stay the course or move to another potentially lower cost plan with the benefits and services needed. Today, with the rising cost of everything, it is an essential and time-consuming task.

The FEHB Medicare Advantage Conundrum

Many Federal Employee’s Health Benefit (FEHB) plans offer a Medicare Advantage (MA) option that appears to provide considerable savings and expanded benefits for federal employees and annuitants. I’ve been a GEHA Standard plan subscriber for the past 10 years; they provided exceptional services and low-cost benefits without fail all these years.

What can their MA Standard and High option provide that I don’t already have? Much to my surprise, their MA options appear to provide considerably more benefits than I had imagined and decided to outline them here for our newsletter subscribers and website visitors.

Who is on First and What is on Second (Abbott and Costello)

There are two GEHA MA plans this year, a standard and high option both managed by United Healthcare, one of the largest healthcare providers nationwide. I’ll focus on the Self Plus One Standard option for this review. The standard monthly premium is $326.79 and the High option costs $540.95.

Actually, GEHA’s standard premium is one of the lowest available and they provide comprehensive coverage and great service overall. There aren’t any additional premiums required when you opt for their Medicare Advantage offerings. Stange but true. Plus, both plans provide a Part B subsidy, $75 for the Standard Plan and $100 for their High Option.

Just the Facts Please

There aren’t any additional premiums for the MA options PLUS your Part B premiums withheld by Social Security decrease by either $75 or $100 for both you and your spouse.

In other words, if you file a joint tax return with a modified adjusted gross income of less than or equal to $206,000 your Part B premium would be $174.70 for each of you. If you are enrolled in the Standard GEHA plan, Social Security will reduce your Party B premium by $75 to $99.70 and your Social Security check will increase by $75 for both you and your spouse!

According to GEHA’s letter sent October 4, 2023 .  “Enrollment is voluntary. Annuitants (and/or their eligible dependents) may opt in or out of the enhanced level of benefits at any time throughout the year.” You don’t need to wait until the next open season to move back to your original plan.

With that cavate, there seems to be little risk. If you aren’t satisfied you can opt out and return to your original GEHA plan and revert back to traditional Medicare Part A and B.

GEHA Standard MA Advantages

The following list highlights some of the major benefits of the FEHB MA Standard option:

  • The MA plan provides a $75 Part B premium subsidy
  • Free gym membership
  • Over-the-counter item allowance of $40
  • No need to coordinate benefits between Medicare and GEHA
  • Eliminates the annual Medical out-of-pocket maximum of $6,500 / $13,000
  • Provides 30 additional acupuncture visits per year
  • Unlimited speech and occupational therapy visits
  • No copayment for durable medical equipment
  • Zero copay for routine podiatry
  • $2,500 hearing aid allowance, limited to UnitedHealthcare hearing network providers

To clarify, the GEHA MA option is a national PPO plan and enrollees pay $0 deductibles, copays, and coinsurance as you currently have under the Standard GEHA plan. This includes $0 for preventative services, physician office visits (primary and specialists), hospital visits, emergency room or urgent care, and ambulance service.

Medicare advantage enrollees will receive a new medical card that you must provide to your doctor’s receptionist during your next visit, and to the pharmacy where your prescriptions are filled. Keep your GEHA card as well, you must remain a GEHA member to enroll in their UnitedHealthcare managed MA plans.

Prescription Drug Tiers (A Significant Advantage)

Once you elect a MA plan, a Medicare Part C Plan, you are automatically enrolled in Medicare Part D drug coverage. Those over 65 and new enrollees in the GEHA Medicare Advantage plan may receive a Late Enrollment Penalty Letter for Part D from Social Security. If you receive this notice, call the plan to let them know it was received. You will not be penalized for a late Part D enrollment when sighing up for a FEHB sponsored MA plan.

Secondly, if you decide to opt out of the program you will not be penalized for Part D late enrollment if you should decide to reenroll down the road.

Significant prescription cost savings

If the actual cost of a drug is less than the normal cost-sharing amount shown on the following chart for that drug, you only pay the actual cost, not the higher cost-sharing amount. I’ve paid less than a dollar for some generic prescriptions.

GEHA provides supplemental drug coverage in addition to your Part D prescription drug benefit when you sign up for their MA plans. The drug copays in this section are for drugs that are covered by both your Part D prescription drug benefit and your supplemental drug coverage.

The Standard GEHA plan cost for a Tier 2 drug is 40% ($250 max) compared to a straight $40 copay under their MA option. I researched two prescriptions that my wife and I were prescribed recently and was amazed at the savings.

Drug Cost Comparisons

  • Jardiance TAB 10MG, $80 for a 90-day supply for the MA plan compared to $500 with GEHA Standard
  • Advair HFA AER 115/21, $40 MA, $157 per month under the GEHA Standard Plan

Check the cost of your prescriptions under the GEHA Standard MA plan. Compare them to the GEHA Standard non-MA plan costs or call GEHA and they will provide the costs for you.

GEHA Standard MA Plan Prescription Drug Costs

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Pharmacy out-of-pocket maximum

When your total out-of-pocket costs (what you pay) reach $3,500 you will not pay any copay or coinsurance.

Cost Savings Analysis

You may run into difficulties if you’re required to pay a higher Part B and D premium based on your income due to the income-related monthly adjustment amount (IRMAA) . The increased premium payments are based on your Modified Adjusted Gross Income (MAGI) .

Only 7% of those on Medicare pay an income adjusted amount for their part B and D premiums.

Most required to pay an IRMAA will be in the first bracket, those filing an individual tax return with a MAGI of greater than $103,000 but less than or equal to $129,000, or those filing a joint return with a MAGI greater than $206,000 but less than or equal to $258,000.

Once you move to a bracket that requires an IRMAA, those enrolled in an MA plan would also pay Part D IRMAA premiums as well.  However, for those in the first bracket, that would only amount to $12.90 . Let’s work up the numbers.

The Numbers Game

For this analysis a couple is filing a joint return with a MAGI of $212,000. They are in the first IRMAA bracket and their premiums will be as follows:

  • $326.79 – GEHA Standard FEHB for Self Plus One
  • $489.20 – Part B premium $174.70 plus an IRMAA of $69.90 ($244.60). Each person will pay $244.60. After the Part B subsidy of $75 is applied, $169.60 would be deducted from each of your Social Security checks monthly.
  • $25.80 – Part D premium, the IRMAA, $12.90 times two, for each person. The $12.90 will also be deducted from each of your Social Security checks every month.

The couple’s total premiums will be $841.79 . This is adjusted down by the Medicare Part B subsidy of $75 per month for each member, two in this case. Social Security will reduce your part B premium by this subsidy therefore increasing each of your Social Security checks by $75.

Essentially, this reduces your total monthly premium by $150 to $691.79 . Then factor in your lower prescription drug costs and the additional benefits such the $40 over-the-counter item allowance and the elimination of the annual medical out-of-pocket maximum. Lots to consider.

Dental and Eye Care Potential Savings

You will also find generous dental and eyecare benefits that may allow you to drop or reduce your FEDVIP coverage . Compare you FEDVIP plan coverage to the GEHA Standard MA plan benefits to see if that is feasible for you.  I would reduce my healthcare benefit costs by another $75 if I dropped my FEDVIP coverage. Here is a link to additional services provided under this MA Plan:

  • Additional Services

Compare Plans

Use OPM’s FEHB Plan Comparison Tool and Consumers’ Checkbook 2024 Guide to Health Plans to find the best FEHB plan for your needs. The Consumers’ Checkbook Guide is available in print and online formats.

Checkbook’s Guide helps active and retired federal employees find a FEHB plan that meets their needs at a cost they can afford. By answering a few questions, a personalized cost estimate is provided for each plan that includes the premium plus expected out-of-pocket costs.

For retirees, Checkbook’s Guide provides a yearly cost estimate for every FEHB plan with Medicare Part A only and a separate estimate with Medicare parts A and B. This allows users to see which plans coordinate best with Medicare, the cost reduction of adding Medicare Part B, and whether the FEHB plan offers Medicare Part B premium rebates.

Federal Retirement readers can order Checkbook’s guide at Guidetohealthplans.org and save 20% by entering promo code FEDRETIRE at checkout. The online and print Guide is available now.

Use these two excellent tools to drill down to and find the plan best suited for your personal situation. Review individual FEHB brochures, they provide the plan’s official statement of benefits.

Precautions

I wrote an article earlier this month that talked about issues hospitals, especially in rural areas were having with certain MA plans. If you missed the article, click on the link below to review it, and read the Caution Section.

  • Prescription Drug Coverage and MA Plans – Part 2

There are always exceptions and it is best to talk with your primary providers to ensure they accept the MA plan you are enrolling in. According to one article I read , “a growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with the private plans altogether.”

Use the following link to see if your providers are in their network:

  • https://retiree.uhc.com/geha/find-a-provider

The FEHB MA plans appear to be more robust and hopefully less susceptible to these issues, more research on my part is needed to confirm this . If anyone reading this has experienced problems with their FEHB MA plans, please let me know so that I can relay them to our subscribers and blog readers.

I’ve been hesitant to switch to a MA plan since they were first introduced under the FEHB umbrella several years ago. Knowing that you can opt out of the GEHA MA program at any time, and revert back to a standard GEHA Self Plus One plan with Medicare A and B is one of the major deciding factors for me. After a little more research on my part, I may sign up before open season ends on December 11 th .

The only reservation is the potential for referrals that may be required under the MA plan for services such as MRIs and various tests that are needed as we age.

Another consideration is that retiree’s income can change each year due to retirement plan RMDs, increased interest and dividend income, and unanticipated capital gains, that could increase your IRMAA in the out years.  If that is the case you can always opt out and return to the Standard GEHA plan. Those in higher IRMAA tiers could end up paying more for their coverage even with Part B subsidies.

I talked with Camille Hemmerich, one of the GEHA UnitedHealthcare Customer Service Advocates this week to verify a number of issues. She was very helpful and we discussed most of the above to one degree or another.

Call their help line at 1-844-491-9898 for clarification that you may need and to sign up. They are available from 8 a.m. to 8 p.m. local times, 7 days a week or visit www.geha.com/MedicareAdvantage .

When you call, be prepared to answer questions to confirm your identity and determine which MA plan you are eligible to enroll in. Camille was able to answer all of my questions to my satisfaction and backed up her replies with references.

Overall, the more I research this option the more attractive it appears to be.

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Disclaimer: The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, and benefit information are subject to change. To ensure the accuracy of this information, contact relevant parties for assistance including OPM’s retirement center. Over time, various dynamic economic factors relied upon as a basis for this article may change.

The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

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Tags: FEHB , FEHB MA , FEHB Open Season , MA and Part B , Medicare Advantage Plans Posted in BENEFITS / INSURANCE , ESTATE PLANNING , FINANCE / TIP , RETIREMENT CONCERNS , SOCIAL SECURITY / MEDICARE , SURVIVOR INFORMATION , UNCATEGORIZED , WELLNESS / HEALTH | Comments (10)

10 Responses to “Comparing FEHB Plans to their Medicare Advantage (MA) Option”

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Need to read and digest

' src=

Have you ever compared retires not taking Medicare part B and keeping normal FEHB?

' src=

My husband and I have also had GEHA standard for many years. And have always been happy with it. Currently it is secondary with Medicare A and B as primary. We too are considering the GEHA – United Health Care Medicare Advantage Plan. I have some concerns about referrals and something called cost sharing when going out of network. Also, I wonder if prior approval is harder to get than with regular GEHA. My biggest concern is the Hearing Aid benefit which only pays when a United Health Care Hearing provider is used. Regular GEHA standard pays the benefit wherever you want to go. I am used to my audiologist who is under United Health Care as a doctor but not a distributor of hearing aids. GEHA says I can still use my hearing aid benefit from GEHA but United Health Care says no, I have to use a United Health Care provider to get the hearing aids. I don’t know who to believe. I have called and chatted several times. What have you decided to do?

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I too have been a GEHA Standard enrollee for many years and I was very interested in the new MA advantage plan. It all looked good until I started checking the in network providers. Not a single quality hospital in my area is included in the network (and only about 1/2 of my physicians). Yes, I know that you can ask the provider to accept payment from UHC and that you also have the option of paying the bill directly and then being reimbursed but do I really want to be bothered with that every time I have a test or need a service from one of the non-network providers. Aetna has a well priced MA plan with quality providers in their network. I think I’m headed that way or I will stay with GEHA std.

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My next article summarizes the feedback I received about FEHB sponsored MA plans in general from the last article. Others had similar issues. This too is my major concern. With GEHA Standard, which I had for years, we never had an issue and paid zero copays, coinsurance, and deductibles since signing up for Medicare 10 years ago. More to come in the next article.

With the GEHA Standard plan, not the MA option, I purchase my hearing aids from Costco. Never had a problem with reimbursement. Referrals are a concern for MA plans in general and the availability of facilities in your area that are on their provider list. Lots to consider. My next article provides more information on this subject that you may find helpful.

No I haven’t, however the Checkbook FEHB Guide compares Plans online with A only and A & B and does this for you. The Guide is available for purchase and Federal Retirement readers can save 20% by entering promo code FEDRETIRE at checkout.

Yes, there is much to be aware of before changing plans.

' src=

Planing on switching from basic BC/BS due to no NH coverage from them. Switching to GEHA standard with medicare. Thought about the MA plan, but if you go out of network from United Health Care , I think there are some hoops to go thru, where as, I don’t think that’s the case with standard/high option with medicare as primary.

' src=

I have had a GEHA High plan for a number of years and have been quite pleased. We did have one provider (Pain Specialist) that said nothing but problems with the UHC (United Health Care) Plan Administrator) for Pre-Auth’s. This is even though Medicare will pay for the requested service. In fact, when he requested a “Peer” review for some denied surgical care his so-called peer was a Gynocologist(!) and the care was denied. There are a number of press reports about health care networks pulling out of agreements where UHC is involved because of a variety of issues (Google it!) I will likely be switching to BCBS High (Standard).

  • Estate Planning Guide Revisited – Setting up Your Plan
  • Considering Your Options – Should You Stay the Course?
  • Tax Forms Availability and Annuity Statements
  • TSP RMDs & Withdrawals Plus Site Navigation Tips
  • Preparing for the New Year – 2024 Updates
  • 2023 in the Rear View Mirror – Observations and Updates
  • T-Bills, Savings Bonds, and CD Investments in the Spot Light
  • MA Plans and the Prescription Drug Plan – Continued
  • Dennis Damp on 2023 in the Rear View Mirror – Observations and Updates
  • Sean A. on 2023 in the Rear View Mirror – Observations and Updates
  • Mark Johnson on Comparing FEHB Plans to their Medicare Advantage (MA) Option
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Driver dead, 5 injured as car crashes into hospital in Austin, Texas

A driver died and five other people, including two children, were injured Tuesday when a car crashed into a hospital in Austin, Texas, officials said.

The number of injured was less than the 10 initially reported. They included a child and an adult hospitalized in critical condition, emergency and hospital officials said at an evening news conference.

The driver of the sedan that plowed into the emergency room area of St. David’s North Austin Medical Center was pulled from the wreckage and received CPR but succumbed to injuries, officials said.

Injured survivors had been in the lobby of the hospital's emergency room section, said Dr. Peter DeYoung, the facility's chief medical officer.

Emergency room doctors swung into action and worked on the driver and others injured by the crash, he said. He called the loss of life a "tragedy."

The two injured children and one of the injured adults were taken to Dell Children’s Medical Center, Austin-Travis County EMS said in an earlier statement.

Water covered part of the facility's floor because the crash ruptured a fish tank, DeYoung said.

Austin police said that a preliminary look at the incident revealed no ill will on the part of the driver but that the matter was still being probed.

"This incident does not appear to be an intentional act," the department said on X.

Christa Stedman, an Austin-Travis County EMS captain, said police assigned vehicular homicide detectives to the case.

hospital

The crash prompted the hospital to close the ER to patients arriving by ambulance, DeYoung said. As many as eight patients already at the facility were being transferred to other facilities as the hospital considers when to reopen to ambulance traffic, he said.

The hospital is one of 16 that offer basic trauma care in the Austin region, according to a Texas nonprofit group that tracks medical care.

The structure of the facility was essentially intact, DeYoung said.

NBC affiliate KXAN of Austin said the crash was reported around 5:36 p.m.

Austin-Travis County EMS designated it as a Level 4 mass casualty incident, which means outside resources could be required. Level 5 is the highest, most urgent level.

A hazardous-materials team was sent to the scene, the Austin Fire Department said on X . It was unclear whether something specific inspired the hazmat response, but hospitals are customarily sites of various hazardous materials.

geha er visit

Dennis Romero is a breaking news reporter for NBC News Digital. 

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Federal Employees: BCBS Basic or GEHA HDHP Health Insurance?

Post by Chindsey » Wed Nov 05, 2014 3:12 pm

User avatar

Re: Federal Employees: BCBS Basic or GEHA HDHP Health Insura

Post by Sbashore » Wed Nov 05, 2014 4:35 pm

Post by cleosdad » Wed Nov 05, 2014 4:48 pm

Sbashore wrote: I have GEHA but not HDHP. I'm satisfied with the way they handle claims and their service in general. My situation is different however. I'm retired and use GEHA as a backup to Medicare.

User avatar

Post by VictoriaF » Wed Nov 05, 2014 4:51 pm

Post by Kaufmanrider » Wed Nov 05, 2014 5:08 pm

Post by PoppyA » Wed Nov 05, 2014 5:19 pm

Post by 111 » Wed Nov 05, 2014 6:05 pm

Post by aj44 » Wed Nov 05, 2014 7:26 pm

Post by Sbashore » Wed Nov 05, 2014 8:51 pm

VictoriaF wrote: Sbashore wrote: I have GEHA but not HDHP. I'm satisfied with the way they handle claims and their service in general. My situation is different however. I'm retired and use GEHA as a backup to Medicare.

Post by Sbashore » Wed Nov 05, 2014 8:52 pm

PoppyA wrote: Sbashore, you say you are using Medicare with standard GEHA. Curious why standard v. High option? Don't mean to high jack this thread. I have used GEHA for years & have been happy. Their rate increases always seem to be amongst the lowest. The network is fine. Only thing I dislike is having to use their lab to get the best rates. Not sure if other plans do that too. Sometimes it is hard to get the docs out of their routine of using "their" lab and using Quest.

Post by Chindsey » Wed Nov 05, 2014 9:20 pm

Post by VictoriaF » Wed Nov 05, 2014 9:25 pm

Sbashore wrote: VictoriaF wrote: Sbashore wrote: I have GEHA but not HDHP. I'm satisfied with the way they handle claims and their service in general. My situation is different however. I'm retired and use GEHA as a backup to Medicare.

Post by Sbashore » Wed Nov 05, 2014 9:43 pm

Post by Kaufmanrider » Wed Nov 05, 2014 11:06 pm

Chindsey wrote: Thank you all for the replies. My wife and I are in our early thirties, and the GEHA HDHP is the only HDHP being offered to federal employees for 2015.

User avatar

Post by Riceman » Wed Nov 05, 2014 11:24 pm

Post by 111 » Wed Nov 05, 2014 11:34 pm

Post by HawkeyeJD » Thu Nov 06, 2014 12:53 am

User avatar

Post by grabiner » Thu Nov 06, 2014 4:34 am

HawkeyeJD wrote: I have BCBS Basic family coverage. I have a spreadsheet that I used to compare the GEHA HDHP to the BCBS basic plan. The GEHA HDHP is a better bet by a large margin if you don't have any significant expenses. Remember, even with the $3000 family deductible all preventatives are paid 100%. For us, I did the math as follows: 1. Premiums Paid for one year (3016 HDHP vs 3848 BCBS) 2. Rebate of Premium into HSA for the year (1500 HDHP, 0 BCBS). Above is your "up front cost" before any medical expenses. HDHP at $1516 vs $3848 BCBS. The HDHP is $3016 in premiums with $1500 passed through to you to your HSA for a net premium of $1516). HDHP is clearly a better value if you don't use anything other than the 100% paid preventative services.

Wiki

Post by ChrisC » Thu Nov 06, 2014 6:14 am

VictoriaF wrote: I did not know that Medicare Part B precludes using HSA. Victoria

Post by HawkeyeJD » Thu Nov 06, 2014 11:32 am

grabiner wrote: HawkeyeJD wrote: I have BCBS Basic family coverage. I have a spreadsheet that I used to compare the GEHA HDHP to the BCBS basic plan. The GEHA HDHP is a better bet by a large margin if you don't have any significant expenses. Remember, even with the $3000 family deductible all preventatives are paid 100%. For us, I did the math as follows: 1. Premiums Paid for one year (3016 HDHP vs 3848 BCBS) 2. Rebate of Premium into HSA for the year (1500 HDHP, 0 BCBS). Above is your "up front cost" before any medical expenses. HDHP at $1516 vs $3848 BCBS. The HDHP is $3016 in premiums with $1500 passed through to you to your HSA for a net premium of $1516). HDHP is clearly a better value if you don't use anything other than the 100% paid preventative services.

Post by wander » Thu Nov 06, 2014 11:59 am

grabiner wrote: You missed an important benefit of the HDHP. You can contribute another $5050 to the HSA tax-deductible, and it can be withdrawn tax-free. If you are in a 30% combined federal and state bracket, that's another $1515 saved, compared to investing the same money in the Roth TSP (which also grows tax-free but is not deductible).

Post by VictoriaF » Thu Nov 06, 2014 1:48 pm

ChrisC wrote: VictoriaF wrote: I did not know that Medicare Part B precludes using HSA. Victoria

Post by VictoriaF » Thu Nov 06, 2014 1:52 pm

wander wrote: grabiner wrote: You missed an important benefit of the HDHP. You can contribute another $5050 to the HSA tax-deductible, and it can be withdrawn tax-free. If you are in a 30% combined federal and state bracket, that's another $1515 saved, compared to investing the same money in the Roth TSP (which also grows tax-free but is not deductible).

Post by Sbashore » Thu Nov 06, 2014 2:12 pm

VictoriaF wrote: ChrisC wrote: VictoriaF wrote: I did not know that Medicare Part B precludes using HSA. Victoria

Post by skepticalobserver » Thu Nov 06, 2014 2:35 pm

Post by that_guy » Thu Nov 06, 2014 6:12 pm

Post by HawkeyeJD » Thu Nov 06, 2014 8:03 pm

VictoriaF wrote: wander wrote: grabiner wrote: You missed an important benefit of the HDHP. You can contribute another $5050 to the HSA tax-deductible, and it can be withdrawn tax-free. If you are in a 30% combined federal and state bracket, that's another $1515 saved, compared to investing the same money in the Roth TSP (which also grows tax-free but is not deductible).

User avatar

Post by baw703916 » Thu Nov 06, 2014 8:39 pm

HawkeyeJD wrote: As a note the math entirely falls apart if you hit catastrophic limits on the HDHP, no amount of tax benefits makes it a better choice than the BCBS or other similar plans. Let's hope that is rare!

User avatar

Post by HueyLD » Thu Nov 06, 2014 9:12 pm

Post by VictoriaF » Thu Nov 06, 2014 11:47 pm

HawkeyeJD wrote: VictoriaF wrote: Purely mathematical comparisons include a fair amount of uncertainty about one's medical conditions and bills in the upcoming year. And they do not account for the insurance company's willingness and ease of paying the bills. And so, in addition to the numerical factors, I use a higher-level consideration: GEHA is a non-for-profit organization, whereas Aetna and BCBS are for-profit. Thus, I assume that I am getting a greater value from GEHA, in whatever ways that value is available to me. Victoria

Post by grabiner » Fri Nov 07, 2014 1:56 am

HawkeyeJD wrote: Since I can't post columns in here I guess, the heading is the category, the top number is the BCBS %, the bottom number is the GEHA HDHP %: Overall Plan Satisfaction 78.18% 60.53%

Post by HawkeyeJD » Fri Nov 07, 2014 3:42 am

grabiner wrote: HawkeyeJD wrote: Since I can't post columns in here I guess, the heading is the category, the top number is the BCBS %, the bottom number is the GEHA HDHP %: Overall Plan Satisfaction 78.18% 60.53%

Post by HawkeyeJD » Fri Nov 07, 2014 3:44 am

VictoriaF wrote: HawkeyeJD wrote: VictoriaF wrote: Purely mathematical comparisons include a fair amount of uncertainty about one's medical conditions and bills in the upcoming year. And they do not account for the insurance company's willingness and ease of paying the bills. And so, in addition to the numerical factors, I use a higher-level consideration: GEHA is a non-for-profit organization, whereas Aetna and BCBS are for-profit. Thus, I assume that I am getting a greater value from GEHA, in whatever ways that value is available to me. Victoria

Post by HawkeyeJD » Fri Nov 07, 2014 4:04 am

baw703916 wrote: HawkeyeJD wrote: As a note the math entirely falls apart if you hit catastrophic limits on the HDHP, no amount of tax benefits makes it a better choice than the BCBS or other similar plans. Let's hope that is rare!

Post by grabiner » Fri Nov 07, 2014 4:21 am

HawkeyeJD wrote: To your question then, the reason this matters is that if I were to max out my HDHP I get some tax benefits as laid out in my other posts. But if I have a serious event like above, I will be out of pocket an additional $5000 in that year which would completely erode any tax benefits I would get that year from the HSA. The actionable items here is that if you have any type of scenario like history of cancer, a TBI, serious cardiac problems, the HDHP is really not the way to go most of the time since any tax benefits are substantially outweighed by the higher maximum out of pocket costs.

Post by HawkeyeJD » Fri Nov 07, 2014 4:33 am

grabiner wrote: HawkeyeJD wrote: To your question then, the reason this matters is that if I were to max out my HDHP I get some tax benefits as laid out in my other posts. But if I have a serious event like above, I will be out of pocket an additional $5000 in that year which would completely erode any tax benefits I would get that year from the HSA. The actionable items here is that if you have any type of scenario like history of cancer, a TBI, serious cardiac problems, the HDHP is really not the way to go most of the time since any tax benefits are substantially outweighed by the higher maximum out of pocket costs.

Post by VictoriaF » Fri Nov 07, 2014 1:07 pm

HawkeyeJD wrote: Right, the catastrophic part is only a consideration in a true insurance sense of what is the most you might have to pay in any one year if worse comes to worse. However, for people with serious chronic conditions that lead to interment large bills, the HDHP plans are often not a good choice conpared to the other plans, just have to run the numbers yourself to see. As I outlined above even without getting anywhere close to out of pocket max, BCBS is better for my family right now but may not be in a few years.

Post by HawkeyeJD » Fri Nov 07, 2014 1:41 pm

VictoriaF wrote: HawkeyeJD wrote: Right, the catastrophic part is only a consideration in a true insurance sense of what is the most you might have to pay in any one year if worse comes to worse. However, for people with serious chronic conditions that lead to interment large bills, the HDHP plans are often not a good choice conpared to the other plans, just have to run the numbers yourself to see. As I outlined above even without getting anywhere close to out of pocket max, BCBS is better for my family right now but may not be in a few years.

Post by HawkeyeJD » Fri Nov 07, 2014 2:04 pm

Chindsey wrote: Good morning, all. My wife and I (both federal employees) are trying to decide whether or not to switch our health insurance coverage from BCBS Basic (Family) to the GEHA HDHP for 2015. We are both in good health, and we have a healthy 7-month-old girl. If we decide to have another child, we most likely wouldn't start trying until mid-to-late 2015 or 2016. Has anyone else considered making/made the switch? What are the main considerations? Have you been happy with the GEHA HDHP? Thank you in advance.

Post by VictoriaF » Fri Nov 07, 2014 2:34 pm

Post by grabiner » Sat Nov 08, 2014 3:02 am

HawkeyeJD wrote: Just as a caveat, you don't need to hit out of pocket max to make the HDHP a potentially bad deal in any given year, my case in point that one child delivery or significant ER visit, based on the way the plans pay, makes the HDHP a less appealing option. As above, 1 ER visit, if that is all you use in one year, assuming the er bill is $5k: with GEHA ends up costing you $1500 premium + $3000 deductible + $100 coinsurance cost = $4600 With the BCBS you get +$3800 premium +$0 deductible + $125 er copay= $3925. So without getting close to out of pocket max, the HDHP is still a less good alternative than traditional coverage if you for see any substantive expense.

Post by supertreat » Thu Nov 19, 2015 11:07 pm

HawkeyeJD wrote: baw703916 wrote: HawkeyeJD wrote: As a note the math entirely falls apart if you hit catastrophic limits on the HDHP, no amount of tax benefits makes it a better choice than the BCBS or other similar plans. Let's hope that is rare!

User avatar

Re: Federal Employees: BCBS Basic or GEHA HDHP Health Insurance?

Post by TimeRunner » Thu Nov 19, 2015 11:37 pm

Post by Kaufmanrider » Fri Nov 20, 2015 12:40 am

Post by VictoriaF » Fri Nov 20, 2015 6:59 pm

TimeRunner wrote: Like Victoria, I re-evaluate my options yearly. I plan on staying with GEHA HDHP in 2016.

Post by ND Fan 1 » Fri Nov 20, 2015 7:37 pm

Post by Sandman11154 » Sat Nov 21, 2015 8:01 pm

Post by Cash » Sun Nov 22, 2015 9:38 pm

Post by savemorelivebetter » Mon Dec 07, 2015 10:11 pm

Cash wrote: I also decided to switch from BCBS Basic to GEHA HDHP this open season. No kids and wife has her own health insurance. Not sure why I didn't do it last year (my first year as a federal employee).

Post by Cash » Sun Dec 13, 2015 4:09 pm

savemorelivebetter wrote: Cash wrote: I also decided to switch from BCBS Basic to GEHA HDHP this open season. No kids and wife has her own health insurance. Not sure why I didn't do it last year (my first year as a federal employee).

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  1. Standard Medical 2024

    Standard medical 2024 A fundamental plan for families of all sizes who want a low deductible and predictable coverage for routine visits Standard Option Rates Services and Costs Prescriptions Documents Enrollment Highlights: Our most family-friendly plan for growing families with 100% maternity coverage

  2. Hdhp 2024

    HDHP 2024 The economical plan for savvy savers whose focus is on future medical needs HDHP Rates Services and Costs Prescriptions Documents Enrollment Highlights: Low premium with lower-than-expected deductible Triple tax advantaged Health Savings Account (HSA) * New for 2024: $1,000/$2,000 GEHA contribution makes your costs even lower

  3. Save time, money and avoid the ER visit

    Everyday health Health and wellness Well-being Telemedicine Getting the right information ahead of time can save you both time and money. According to the Centers for Disease Control and Prevention, the number of emergency room visits in the United States has jumped by nearly 25% in the past 10 years and a whopping 61.2% over the last 20 years.

  4. PDF 2021 GEHA Standard Option Summary of Benefits and Coverage

    2021 GEHA Standard Option Summary of Benefits and Coverage Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 - 12/31/2021 Standard Option: GEHA Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: PPO 1 of 8 Excluded Services & Other Covered Services:

  5. Elevate Plus 2024

    Specialist copay of $50 per visit Earn rewards with the Rally ® digital health platform Mental health benefit, including telehealth, from MDLIVE Vision discounts and $0 annual eye exam included with EyeMed 1 2024 Elevate Plus rates These rates do not apply to all enrollees.

  6. As ER overcrowding worsens, a program helping to ease the crisis may

    With no available room in the hospital, Day found himself stuck in the ER, twice. On one visit, Day developed a bed sore from remaining stationary for more than 26 hours.

  7. GEHA Field at Arrowhead Stadium

    GEHA Field at Arrowhead Stadium is home to the Kansas City Chiefs and Chiefs Kingdom. It is one of the most iconic stadiums in the NFL, and holds the world record for the loudest crowd roar at a sports stadium at 142.2 dbA.

  8. Medicare and emergency room visits: Coverage and limits

    Medicare Part B usually covers emergency room (ER) visits, unless a doctor admits a person to the hospital for a certain length of time. For inpatient admissions, Medicare Part A may cover...

  9. I'm not sure I understand the GEHA HDHP appeal : r/fednews

    A plan like GEHA standard has a slightly cheaper premium at $68.77, a deductible of $350, and covers way more. ... For our speech therapy visits it's $3.xx and physical therapy is $4.xx --- a big factor in me keeping GEHA HDHP versus a copay plan. ... An ER visit or hospital stay at 5% is still going to be more expensive than the flat rates you ...

  10. The problem with United Healthcare's plan to crack down on ER use

    A 2017 study, which sought to encourage uninsured Virginians to visit a primary care physician instead of the ER, found that there was a modest reduction in non-urgent visits to the emergency ...

  11. How is GEHA HDHP not a scam? What's the catch? : r/fednews

    GEHA HDHP TOTAL COSTS: 4 PRIMARY CARE VISITS (77.6) 9 SPECIALISTS VISITS (207) 1 ER VISIT ($250) 2 URGENT CARE VISITS (16.5) ... ER visit is 0 on high, and specialist is $35 on standard. There is also the full price until deductible, office visit is like $125. Reply reply Prestigious_Mango_88 ...

  12. When Insurers Deny Emergency Department Claims

    But Anthem caused controversy in 2017 with new rules in six states (Georgia, Indiana, Missouri, Ohio, New Hampshire, and Kentucky ) that shifted the cost of ER visits to the patient if a review of the claim and the patient's diagnosis (as opposed to symptoms) determines that the situation was not an emergency after all.

  13. GEHA-Livecare Benefits Employee Health Benefits MDLIVE Healthcare

    GEHA medical members get 24/7 virtual access to doctors therapists, and dermatologists. ... dermatology and behavioral health visits: $0 for Elevate, Standard Option, Elevate Plus and High Option members, ... MDLIVE is an inexpensive alternative to the emergency room or urgent care center; MDLIVE Providers are available after hours, nights ...

  14. Comparing FEHB Plans to their Medicare Advantage (MA) Option

    To clarify, the GEHA MA option is a national PPO plan and enrollees pay $0 deductibles, copays, and coinsurance as you currently have under the Standard GEHA plan. This includes $0 for preventative services, physician office visits (primary and specialists), hospital visits, emergency room or urgent care, and ambulance service.

  15. GEHA HDHP 2023

    TL;DR: I switched from BCBS Basic in open season 2022 for calendar year 2023. As of October 2023 my medical bills for the family include a high risk pregnancy, newborn requiring ER visit turned into surgery and hospital stay, multiple urgent care visits, and other primary care visits. I am waiting to see if I get some more bills from the hospital.

  16. FEHB BCBS Basic vs. GEHA HDHP

    After meeting the $1500/3000 deductible GEHA copay is 5% for office visit (primary and specialist). This is usually cheaper than the BCBS's $30/40 copy for office visit. ... My total co-pays for the ER visit, various tests, hospital stay etc were less than $500. I see a 5% copay mentioned for GEHA, which would be nearly $4,000.

  17. GEHA Elevate Plus and insurance questions- is it worth it to ...

    • 3 mo. ago I never really looked at GEHA's Elevate plans. And after just glancing through their website, I don't even know why Elevate Plus even exists. As far as I can tell GEHA Standard is better in every way. I'd personally recommend their HDHP, but their Standard plan looks better than Elevate plus. BCBS Basic looks better than Elevate Plus.

  18. How does GEHA HDHP work? : r/fednews

    The GEHA HDHP is very low for a HDHP. Combined with the low cost, $900 pass through, and ability to have all of your other expenses tax-free, I'd say do the math. Unless you need major procedures every year, there's a good chance you can have a large, tax-free, investment account for that rainy day. PEfarmer.

  19. Your ER Experience: What to Expect at Every Step

    Acuity scale of your visit (from most life-threatening, or 1, to least life-threatening, or 5) Chief complaint (reason for your visit to the emergency room) Symptoms . Vitals (blood pressure, pulse and temperature) Your Evaluation With a Medical Provider . Next, you'll be seen by a medical provider in an appropriate space in the emergency room.

  20. Driver dead, 5 hurt as car crashes into hospital in Austin, Texas

    The driver of the sedan that plowed into the emergency room area of St. David's North Austin Medical Center was pulled from the wreckage and received CPR but succumbed to injuries, officials said.

  21. GEHA Elevate Plus vs Standard : r/fednews

    Standard here and considered switching to Elevate plus because of the no co pay and ER and surgery is a flat rate of $150-$200. In the past year my son and I have had 3 ER visits and 1 surgery. We paid 15% under the standard for each instance. However, while no deductible and the flat rate ER and surgery is nice.

  22. Federal Employees: BCBS Basic or GEHA HDHP Health Insurance?

    cleosdad Posts: 302 Joined: Sat Feb 02, 2008 2:32 pm Location: Littleton Co Re: Federal Employees: BCBS Basic or GEHA HDHP Health Insura by cleosdad » Wed Nov 05, 2014 4:48 pm Sbashore wrote: I have GEHA but not HDHP. I'm satisfied with the way they handle claims and their service in general.

  23. 5 Things To Do After Your ER Visit

    1. Make Your Next Appointment After an ER visit, you may need to see a new health care provider, get tests done or see your primary care provider (PCP). As a general rule, your next appointment should be within seven days of your discharge date and can be in person or via telehealth — a video or phone call. 2. Speak With Your PCP