Feds - Is GEHA Still The Best HDHP Option?

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Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

Dear friends,

Is GEHA still the best HDHP option for Feds? It's been a few years since I have signed up and not sure if benefits have changed. I recently got preventative labs done and now I have to pay a deductible. Previously, I believe it was covered 100% as long as it's an ACA test?

Just want to confirm. Thanks in advance.
Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

A bump for those that missed this earlier :beer
cowbman
Posts: 366
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Re: Feds - Is GEHA Still The Best HDHP Option?

Post by cowbman »

Many here recommend the FEHB Checkbook. You may wish to peruse that. This being said, GEHA HDHP is one of the better priced plans.
Last edited by cowbman on Thu Aug 04, 2022 1:35 am, edited 1 time in total.
grok87
Posts: 10056
Joined: Tue Feb 27, 2007 9:00 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by grok87 »

RJC wrote: Wed Aug 03, 2022 8:34 am Dear friends,

Is GEHA still the best HDHP option for Feds? It's been a few years since I have signed up and not sure if benefits have changed. I recently got preventative labs done and now I have to pay a deductible. Previously, I believe it was covered 100% as long as it's an ACA test?

Just want to confirm. Thanks in advance.
GEHA = Government Employees Health Association
https://www.geha.com/
HDHP = High Deductible Health Plan
ACA = Affordable Care Act

cheers,
grok
RIP Mr. Bogle.
Super Hans
Posts: 213
Joined: Sat Jul 14, 2012 9:18 pm
Location: Washington, D.C.

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by Super Hans »

In this specific situation, I don't think there's been a substantive plan change for the worse. I think you're just in medical coding hell, where the same tests almost randomly get treated as preventive or diagnostic. I've been through this before, including appealing decisions, but fortunately these kinds of tests typically aren't too expensive anyway. Ultimately, after making a big deal of it, GEHA ended up paying for things that were pretty borderline and yet not paying for pretty clearly preventive services they had paid in full previously. The culprit may be a stubborn internist who insisted his coding was correct when I'm sure he did it in a way that caused the trouble.

In short, HDHP arbitrary treatment of preventive claims seems like it may occur across all plans and not be predictable.
FedRetired2018
Posts: 4
Joined: Fri Nov 22, 2019 8:54 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by FedRetired2018 »

I started with the GEHA HDHP in 2021 after years with a non-HDHP FEHB plan. The issue of labs and what is covered as "preventative labs" was a tough one to wrap my head around. Under my previous non-HDHP plans, the "usual lab work" ordered as part of an annual physical (preventive care) was covered by the insurance plan. Not so for the HDHP plan.

It took me four phone calls but I finally got an explanation. "Preventive care" is not defined by lab tests. It is recommendations by disease. It's preventative screenings recommended by the US Preventive Services Task Force (USPSTF) with A or B rating, such as: lung cancer, osteoporosis, depression, diabetes, high blood pressure, total blood cholesterol, HIV, hepatitis C infection ... (see pg 42 of the 2022 brochure).

In 2021, the GEHA HDHP plan covered two of the routine lab tests that are part of annual physical - lipids (code 80061), hemoglobin A1C (code 83036). It did not consider blood glucose or urine glucose part of monitoring for diabetes. That is a choice made by the plan. Any other lab testing you pay for up to the deductible. Once you've met the deductible, it's 5% for in-network.

The reason the lab work was "fully covered" under the non-HDHP plans I had in previous years was because it was paid under the lab benefit (a no cost for in network lab work benefit of the plan).

The GEHA HDHP is a great plan. You can use the HSA to pay for the lab work or pay out of pocket and let the HSA continue to grow tax-free. Paying for the lab work was a surprise but once I got a representative that understood the HDHP plan and could explain it to me, it all made sense. It sure would be nice if that was explained in the brochures.
Haysnooze
Posts: 30
Joined: Wed Oct 02, 2019 5:24 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by Haysnooze »

GEHA HDHP is great for everything except expensive medicines. If you are on expensive medicines, look at a different plan. If you are in the DC area, also look at Carefirst HDHP. For some people that will be better and others GEHA better. Not a HDHP, but I switched from GEHA HDHP to Foreign Service Benefit Plan (FSBP) because our child got put on an expensive medication. I liked the triple tax savings of the HDHP, but think FSBP works better for our family.
Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

cowbman wrote: Wed Aug 03, 2022 3:40 pm Many here recommend the FEHB Checkbook. You may wish to peruse that. This being said, GEHA HDHP is one if the better priced plan.
The FEHB Checkbook has been helpful and was one of the reasons why I picked GEHA HDHP originally. Glad to hear it's still considered a good plan.
Topic Author
RJC
Posts: 1219
Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

grok87 wrote: Wed Aug 03, 2022 3:43 pm
RJC wrote: Wed Aug 03, 2022 8:34 am Dear friends,

Is GEHA still the best HDHP option for Feds? It's been a few years since I have signed up and not sure if benefits have changed. I recently got preventative labs done and now I have to pay a deductible. Previously, I believe it was covered 100% as long as it's an ACA test?

Just want to confirm. Thanks in advance.
GEHA = Government Employees Health Association
https://www.geha.com/
HDHP = High Deductible Health Plan
ACA = Affordable Care Act

cheers,
grok
Thanks for translating!
raizar29
Posts: 27
Joined: Mon Nov 16, 2020 2:41 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by raizar29 »

I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
Topic Author
RJC
Posts: 1219
Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

Super Hans wrote: Wed Aug 03, 2022 3:46 pm In this specific situation, I don't think there's been a substantive plan change for the worse. I think you're just in medical coding hell, where the same tests almost randomly get treated as preventive or diagnostic. I've been through this before, including appealing decisions, but fortunately these kinds of tests typically aren't too expensive anyway. Ultimately, after making a big deal of it, GEHA ended up paying for things that were pretty borderline and yet not paying for pretty clearly preventive services they had paid in full previously. The culprit may be a stubborn internist who insisted his coding was correct when I'm sure he did it in a way that caused the trouble.

In short, HDHP arbitrary treatment of preventive claims seems like it may occur across all plans and not be predictable.
I'm starting to think this is it. Some labs they pay 100% and others at a negotiated rate. Yes, I am glad overall the deductibles were relatively minor.
Topic Author
RJC
Posts: 1219
Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

FedRetired2018 wrote: Wed Aug 03, 2022 3:49 pm I started with the GEHA HDHP in 2021 after years with a non-HDHP FEHB plan. The issue of labs and what is covered as "preventative labs" was a tough one to wrap my head around. Under my previous non-HDHP plans, the "usual lab work" ordered as part of an annual physical (preventive care) was covered by the insurance plan. Not so for the HDHP plan.

It took me four phone calls but I finally got an explanation. "Preventive care" is not defined by lab tests. It is recommendations by disease. It's preventative screenings recommended by the US Preventive Services Task Force (USPSTF) with A or B rating, such as: lung cancer, osteoporosis, depression, diabetes, high blood pressure, total blood cholesterol, HIV, hepatitis C infection ... (see pg 42 of the 2022 brochure).

In 2021, the GEHA HDHP plan covered two of the routine lab tests that are part of annual physical - lipids (code 80061), hemoglobin A1C (code 83036). It did not consider blood glucose or urine glucose part of monitoring for diabetes. That is a choice made by the plan. Any other lab testing you pay for up to the deductible. Once you've met the deductible, it's 5% for in-network.

The reason the lab work was "fully covered" under the non-HDHP plans I had in previous years was because it was paid under the lab benefit (a no cost for in network lab work benefit of the plan).

The GEHA HDHP is a great plan. You can use the HSA to pay for the lab work or pay out of pocket and let the HSA continue to grow tax-free. Paying for the lab work was a surprise but once I got a representative that understood the HDHP plan and could explain it to me, it all made sense. It sure would be nice if that was explained in the brochures.
This explains perfectly. Thank you.

I have been struggling to understand what "preventative care" meant in terms of labs. It's not like these labs were ordered due to an issue. It's just a part of the preventative care appointment I make annually.
Topic Author
RJC
Posts: 1219
Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

Haysnooze wrote: Wed Aug 03, 2022 4:01 pm GEHA HDHP is great for everything except expensive medicines. If you are on expensive medicines, look at a different plan. If you are in the DC area, also look at Carefirst HDHP. For some people that will be better and others GEHA better. Not a HDHP, but I switched from GEHA HDHP to Foreign Service Benefit Plan (FSBP) because our child got put on an expensive medication. I liked the triple tax savings of the HDHP, but think FSBP works better for our family.
That is what I heard as well. If you have expensive medication or are on long-term maintenance care.
tj
Posts: 6298
Joined: Thu Dec 24, 2009 12:10 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by tj »

FedRetired2018 wrote: Wed Aug 03, 2022 3:49 pm I started with the GEHA HDHP in 2021 after years with a non-HDHP FEHB plan. The issue of labs and what is covered as "preventative labs" was a tough one to wrap my head around. Under my previous non-HDHP plans, the "usual lab work" ordered as part of an annual physical (preventive care) was covered by the insurance plan. Not so for the HDHP plan.

It took me four phone calls but I finally got an explanation. "Preventive care" is not defined by lab tests. It is recommendations by disease. It's preventative screenings recommended by the US Preventive Services Task Force (USPSTF) with A or B rating, such as: lung cancer, osteoporosis, depression, diabetes, high blood pressure, total blood cholesterol, HIV, hepatitis C infection ... (see pg 42 of the 2022 brochure).

In 2021, the GEHA HDHP plan covered two of the routine lab tests that are part of annual physical - lipids (code 80061), hemoglobin A1C (code 83036). It did not consider blood glucose or urine glucose part of monitoring for diabetes. That is a choice made by the plan. Any other lab testing you pay for up to the deductible. Once you've met the deductible, it's 5% for in-network.

The reason the lab work was "fully covered" under the non-HDHP plans I had in previous years was because it was paid under the lab benefit (a no cost for in network lab work benefit of the plan).

The GEHA HDHP is a great plan. You can use the HSA to pay for the lab work or pay out of pocket and let the HSA continue to grow tax-free. Paying for the lab work was a surprise but once I got a representative that understood the HDHP plan and could explain it to me, it all made sense. It sure would be nice if that was explained in the brochures.
How did you obtain the codes? They aren't included on EOB.


In my experience, they covered:

LIPID PANEL
ASSAY THYROID STIM HORMONE
GLYCOSYLATED HEMOGLOBIN TEST

they did not cover, but negotiated better price:
METABOLIC PANEL,COMPREHENSIVE
ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS


It didnt make any sense to me why the Comprehensive Metabolic Panel was not preventative.
grok87
Posts: 10056
Joined: Tue Feb 27, 2007 9:00 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by grok87 »

RJC wrote: Thu Aug 04, 2022 7:09 am
grok87 wrote: Wed Aug 03, 2022 3:43 pm
RJC wrote: Wed Aug 03, 2022 8:34 am Dear friends,

Is GEHA still the best HDHP option for Feds? It's been a few years since I have signed up and not sure if benefits have changed. I recently got preventative labs done and now I have to pay a deductible. Previously, I believe it was covered 100% as long as it's an ACA test?

Just want to confirm. Thanks in advance.
GEHA = Government Employees Health Association
https://www.geha.com/
HDHP = High Deductible Health Plan
ACA = Affordable Care Act

cheers,
grok
Thanks for translating!
:)
RIP Mr. Bogle.
Topic Author
RJC
Posts: 1219
Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
I do love how it covers some dental and vision. I haven't tried the rewards program but maybe I should look into it now that you bring it up!
tj
Posts: 6298
Joined: Thu Dec 24, 2009 12:10 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by tj »

RJC wrote: Thu Aug 04, 2022 8:34 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
I do love how it covers some dental and vision. I haven't tried the rewards program but maybe I should look into it now that you bring it up!
You can earn 250 per year rollover 1250. It's free $$.
vasaver
Posts: 313
Joined: Fri Oct 19, 2012 2:15 pm
Location: Virginia

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by vasaver »

raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
tj
Posts: 6298
Joined: Thu Dec 24, 2009 12:10 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by tj »

vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
There's a form you can fill out and send to them. I didn't call.
Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

tj wrote: Thu Aug 04, 2022 9:02 pm
vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
There's a form you can fill out and send to them. I didn't call.
When did this happen? I will have to set this up as well! Thanks all.
Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
Is Schwab cheaper than SPTM (State Street S&P Composite Index, 0.03% ER)?
tj
Posts: 6298
Joined: Thu Dec 24, 2009 12:10 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by tj »

RJC wrote: Fri Aug 05, 2022 7:07 am
tj wrote: Thu Aug 04, 2022 9:02 pm
vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
There's a form you can fill out and send to them. I didn't call.
When did this happen? I will have to set this up as well! Thanks all.
I don't know. I'm pretty sure someone linked the PDF here.
FedRetired2018
Posts: 4
Joined: Fri Nov 22, 2019 8:54 am

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by FedRetired2018 »

tj wrote: Thu Aug 04, 2022 5:18 pm
FedRetired2018 wrote: Wed Aug 03, 2022 3:49 pm I started with the GEHA HDHP in 2021 after years with a non-HDHP FEHB plan. The issue of labs and what is covered as "preventative labs" was a tough one to wrap my head around. Under my previous non-HDHP plans, the "usual lab work" ordered as part of an annual physical (preventive care) was covered by the insurance plan. Not so for the HDHP plan.

It took me four phone calls but I finally got an explanation. "Preventive care" is not defined by lab tests. It is recommendations by disease. It's preventative screenings recommended by the US Preventive Services Task Force (USPSTF) with A or B rating, such as: lung cancer, osteoporosis, depression, diabetes, high blood pressure, total blood cholesterol, HIV, hepatitis C infection ... (see pg 42 of the 2022 brochure).

In 2021, the GEHA HDHP plan covered two of the routine lab tests that are part of annual physical - lipids (code 80061), hemoglobin A1C (code 83036). It did not consider blood glucose or urine glucose part of monitoring for diabetes. That is a choice made by the plan. Any other lab testing you pay for up to the deductible. Once you've met the deductible, it's 5% for in-network.

The reason the lab work was "fully covered" under the non-HDHP plans I had in previous years was because it was paid under the lab benefit (a no cost for in network lab work benefit of the plan).

The GEHA HDHP is a great plan. You can use the HSA to pay for the lab work or pay out of pocket and let the HSA continue to grow tax-free. Paying for the lab work was a surprise but once I got a representative that understood the HDHP plan and could explain it to me, it all made sense. It sure would be nice if that was explained in the brochures.
How did you obtain the codes? They aren't included on EOB.


In my experience, they covered:

LIPID PANEL
ASSAY THYROID STIM HORMONE
GLYCOSYLATED HEMOGLOBIN TEST

they did not cover, but negotiated better price:
METABOLIC PANEL,COMPREHENSIVE
ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS


It didnt make any sense to me why the Comprehensive Metabolic Panel was not preventative.

I had to call GEHA for the codes. Another hoop to jump through to get the information you need to reconcile billing.
vasaver
Posts: 313
Joined: Fri Oct 19, 2012 2:15 pm
Location: Virginia

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by vasaver »

RJC wrote: Fri Aug 05, 2022 7:28 am
vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
Is Schwab cheaper than SPTM (State Street S&P Composite Index, 0.03% ER)?
I think SPTM is an ETF? - TD Ameritrade only allowed me to do automatic investing for mutual funds last I checked.

Here is the screener log in for full features https://research.tdameritrade.com/grid/ ... erview.asp

Schwab low cost funds below 0.07% - it looks like SWPPX is 0.02%
https://research.tdameritrade.com/grid/ ... rid_VENDOR
Topic Author
RJC
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Joined: Fri Dec 14, 2018 1:40 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by RJC »

vasaver wrote: Sun Aug 07, 2022 12:45 am
RJC wrote: Fri Aug 05, 2022 7:28 am
vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
Is Schwab cheaper than SPTM (State Street S&P Composite Index, 0.03% ER)?
I think SPTM is an ETF? - TD Ameritrade only allowed me to do automatic investing for mutual funds last I checked.

Here is the screener log in for full features https://research.tdameritrade.com/grid/ ... erview.asp

Schwab low cost funds below 0.07% - it looks like SWPPX is 0.02%
https://research.tdameritrade.com/grid/ ... rid_VENDOR
Got it. Thank you.
raizar29
Posts: 27
Joined: Mon Nov 16, 2020 2:41 pm

Re: Feds - Is GEHA Still The Best HDHP Option?

Post by raizar29 »

tj wrote: Thu Aug 04, 2022 9:02 pm
vasaver wrote: Thu Aug 04, 2022 8:59 pm
raizar29 wrote: Thu Aug 04, 2022 7:16 am I'm extremely happy with it. It covers standard dental and vision expenses which are the majority of my medical costs. It has a great rewards program to earn money for medical expenses not covered by insurance. The HSA allows you to invest with TD Ameritrade, giving you a decent array of options (although I do wish automatic investment was an option).
We were able to setup automatic investing - it just has to be a mutual fund and you have to call in to have it setup. I think the Schwab index funds were the cheapest and you just have to pick the day(s) of the month for auto investing. :sharebeer
There's a form you can fill out and send to them. I didn't call.
Awesome! I found the form today and submitted through secure email. Fingers crossed!
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