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LynMichel  
#1 Posted : Tuesday, November 1, 2016 3:19:19 PM(UTC)

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I was wondering about GEHA Health Insurance? Does anyone have GEHA? How does it compare to Blue Cross Basic or any other health insurance?
Thank you.
upandup  
#2 Posted : Tuesday, November 1, 2016 4:03:23 PM(UTC)

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GEHA is the second largest insurer by enrollment in FEHB (after BCBS Service Benefit Plan). It uses different networks in different states (most states are either Aetna or United HealthCare). The standard plan and HDHP are good values. The high option is on the expensive side.
Sante123  
#3 Posted : Tuesday, November 1, 2016 9:02:23 PM(UTC)
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I’ve had GEHA Standard for the past two years and am pleased with the service. Unlike some plans, the GEHA deductible does not apply to office visits or drugs. So you pay a flat $15 for primary care visits ($30 for specialists) and $10 or less for generic drugs. The provider network in my state (Aetna) is extensive, so no problem finding participating doctors or hospitals. Now that they’ve upgraded their data systems, GEHA pays claims without undue delay once the provider submits the bill. Customer service has been professional and easy to reach. Their wellness benefits are substantial and the plan's website is full of useful information. Once or twice a year, the CEO hosts a one-hour online chat session to respond to member questions and/or gripes. A nice touch.

Premiums are low and annual rate increases have trended lower than the FEHB average. Plus there’s wrap-around coverage for retired members with Medicare Parts A+B. Standard option is a solid choice unless you have a lot of name brand prescriptions. If so, consider the pricier High Option or other plans with rich drug benefits.

Edited by user Wednesday, November 16, 2016 8:47:49 AM(UTC)  | Reason: added "name brand" to prescriptions

sarmikreb  
#4 Posted : Monday, November 28, 2016 4:00:37 PM(UTC)

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Originally Posted by: LynMichel Go to Quoted Post
I was wondering about GEHA Health Insurance? Does anyone have GEHA? How does it compare to Blue Cross Basic or any other health insurance?
Thank you.


My experience with GEHA standard is that it is relatively inexpensive, but GEHA questions medical services and treatments and refuses to pay their share of medical bills too often. My wife and I are switching from GEHA during open season due to GEHA's desire to constantly look for reasons not to pay medical bills.
Hired 2015  
#5 Posted : Wednesday, November 30, 2016 4:20:15 AM(UTC)
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GEHA medical provider and supplier information in my area it appears has not been updated in years. My advise would be to pay close attention to the physical address listed for doctors and suppliers. In my situation GEHA listed my doctor at a physical address that the building did not exist anymore. GEHA would not cover my doctors bills at the doctor's new office address and insisted they would of been covered if I had gone to the prior address which because the building did not exist would of been a challenge.

My dentist refused to work with GEHA and would not submit a dental claim so I had to submit the claim. There was alot of time consuming work on my end to get claims paid.

GEHA medical providers in my area (Indiana) would not collect copays. The prescriptions offered through the mail in service cost more than if I had paid cash at the local pharmacy. I had to pay $100 for prescriptions I could of gotten for $45 at the pharmacy without insurance at the cash price. The mail in service changed the brands of my prescriptions while refusing to refill epi pens. They couldn't tell me for sure which hospital was in network.

It took 6 months to get prescribed medical equipment supplies and my providers can them to me for free because GEHA kept changing the rules. All of my concerns here to the OPM on appeal. I had to take furlough because of the ethical questions of GEHA providers refusing to accept copays and offering free services.

Like millions of Americans even in Indiana I was better off on state medicaid where I did not experience the problems I did with GEHA to get basic medical care. In other words why bother working when I could sit on Indiana medicaid that paid in full all of my medical bills.

I was knocking on heavens door for sure with GEHA. The irony is I am from Wisconsin originally. Saved by the Indiana medicaid program reform under Governor Daniels. Right to work didn't seem to workout because I lost the medicaid. It was the Indiana medicaid work program that referred me to federal job board.

I am just a Wisconsin kid. I should of stayed on medicaid.



wcweaver16  
#6 Posted : Wednesday, November 30, 2016 11:02:35 AM(UTC)
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Originally Posted by: sarmikreb Go to Quoted Post
Originally Posted by: LynMichel Go to Quoted Post
I was wondering about GEHA Health Insurance? Does anyone have GEHA? How does it compare to Blue Cross Basic or any other health insurance?
Thank you.


My experience with GEHA standard is that it is relatively inexpensive, but GEHA questions medical services and treatments and refuses to pay their share of medical bills too often. My wife and I are switching from GEHA during open season due to GEHA's desire to constantly look for reasons not to pay medical bills.


I had BC/BS forever and then last year switched to AETNA DIRECT. I t has been great and flawless. We have had three major surgries and other expensive testing this year and we have paid $0. And that includes medicines, again $0 copays.

The rates are very very competitive.

The only caveat is this is for retirees on Medicare Part B. But his plan will reimburse you for part of your Medicare part B premiums if you want!

For retirees the plan is almost too good to be true, but we have had absolutely nothing but a great experience with AETNA DIRECT.

Edited by user Wednesday, November 30, 2016 11:05:18 AM(UTC)  | Reason: Not specified

baileysinut  
#7 Posted : Thursday, December 1, 2016 7:02:06 AM(UTC)
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I agree 100% wcweaver16! Aetna Direct seemed too good to be true last year but now we are witnesses of how great it is! I tell anyone who will listen if they have Medicare A and B, don't waste a minute! Sign up with Aetna Direct! Best Plan for retirees with Medicare A and B! My daughter had GEHA years ago, got incurable cancer and had a tremendous amount of expensive prescriptions and they would only pay 50%. They could hardly wait for the year to end so they could change insurance carriers! Look hard and long at that one!
Sante123  
#8 Posted : Thursday, December 1, 2016 8:59:37 PM(UTC)
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LynMichel:

As you can see from the above posts, when you ask for online advice about a plan, what you often get is anecdotal feedback. It is of little benefit to you if someone (myself included) had a good or bad experience with insurance plan X. What you should be seeking are comparative details on plan coverage, catastrophic limits, network coverage in your locality, typical costs for the kind of care YOU will likely need, etc. In other words, you need to do some homework of your own. OPM’s website offers useful info. Another good source is the Checkbook Guide to Health Plans for Federal Employees and Annuitants.

Each plan is set up to attract a certain universe of enrollees. There is no one best plan, just those that best fit your situation. If you need lots of name brand or non-formulary prescriptions, don’t sign up for a plan that features higher drug co-insurance payments. If you’re retired or have a limited income, don’t sign up for HDHP plans because their HSA tax advantages are better suited for higher income folks who are not yet enrolled in any part of Medicare. If your preferred providers are not in a plan’s network (ask the providers before signing up), then be sure you can afford the out of network co-insurance. If you can’t, get a different provider or a different plan with a different network. If you can’t afford or don’t wish to pay high premiums, don’t expect your low-cost plan to be as generous as one whose premiums cost 50-100% more. And if the plan brochure says that there are limits on certain kinds of care, or alternate benefit procedures, or step drug therapy in lieu of name brand drugs, don’t be surprised if that is exactly what happens.

Also, be aware that each year OPM issues a call letter which lays out expectations for what FEHB plans can offer. Current expectations include: lowering costs (primarily for the plan and OPM, not you), more restrictive drug coverage (step therapy, managed formularies, tiered pricing, etc.), and incentivizing retirees to enroll in Medicare A+B. All FEHB plans are subject to these requirements.

If you’d like a plan that pays for just about everything and costs very little, rest assured that it will have some combination of: a smaller provider network, costlier out-of-network co-insurance, less generous drug benefits, less robust catastrophic maximum protection, little or no routine dental/vision benefits, less generous coverage for folks not on Medicare, and/or assorted pre-authorization requirements. That’s why BCBS basic pays NOTHING for out of network providers. That’s why Aetna Direct is not nearly as good a deal when all covered beneficiaries are not on Medicare Parts A+B as when they are. That’s also why many plans with the cheapest premiums expose you to some of the highest catastrophic maximum costs.

Occasionally, some plans offer a really sweet deal, like APWU CDHP did for many years. But sweet deals attract high-cost enrollees looking for inexpensive plans. Eventually, something’s got to give, and it has. From 2015-17, APWU CDHP premiums rose 29%, while GEHA Standard went up just over 4%. Similarly, from 2008-17 premiums for the generous standard HMO plan offered by Northern California Kaiser rose a whopping 223%! During that same period, GEHA Standard rose just 53%. Over time, plans that offer too much become costlier because they tend to shed low-cost, price conscious participants while gaining high cost participants. This is called adverse selection and it can have a deadly effect on a plan’s long-term viability. This is where a not too hot, not too cold, just right plan like GEHA Standard comes in.

GEHA Standard is the type of plan that works well for young people with low medical expenses while also being a good deal for retirees on Medicare. As such, its pool of enrollees averages out to being not too old or too sick. And since prescription drugs constitute 30% of all FEHB medical costs, GEHA Standard’s good-but-not-great drug coverage helps keep premiums low. Aetna Direct, by comparison, unapologetically shoots for the retired-on-Medicare crowd while offering middle-of-the-road drug benefits that sometimes beat GEHA’s and sometimes don’t. For non-drug services, it’s paying only 20% of costs after Medicare, so the savings can be re-directed into the medical savings account. And don’t forget that Medicare costs are artificially lower to begin with because the government limits the prices providers can charge. However, Aetna Direct’s coverage for non-retirees is less attractive. For non-retirees, Aetna Direct and GEHA Standard are closely matched from a total package perspective. If one, but not all covered individuals in a household are retired and on Medicare, the two plans are still closely matched. But if each covered individual is retired and on Medicare, then Aetna Direct does have the advantage over GEHA Standard. If the latter scenario describes your situation, you should consider Aetna Direct.
Sante123  
#9 Posted : Tuesday, January 24, 2017 10:14:36 PM(UTC)
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My prior comment probably gave the impression that GEHA Standard and Aetna Direct were somehow neck-and-neck in overall coverage when it comes to non-retired enrollees. They are close, and the Checkbook Guide certainly likes the savings account aspect of CDHP plans like Aetna Direct. However, I actually think GEHA is a better deal for active employees and retirees not yet enrolled in Medicare Parts A+B. Here’s why…

1) Aetna Direct’s medical savings account does not necessarily represent equivalent out-of-pocket savings over GEHA Standard. Why not? Because, unlike Aetna, GEHA does not apply the deductible to office visits and prescriptions. So you pay only small, predictable co-pays, no matter how many office visits or generic prescriptions you may have. Under Aetna Direct, your HRA (aka medical savings account) is obliged to pay the full contract rate for prescriptions and diagnostic office visits. Rx prices can vary month to month (even among generics) and different providers can charge quite a lot for office visits. In my area, for example, $300-$400 is not uncommon for office visits. As a result, the depletion of Aetna Direct HRA funds can occur much faster than the buildup of GEHA co-pays. For example, at $300 per visit, three diagnostic visits would cost you a total of $45 in GEHA Standard co-pays, or as little as zero under Aetna Direct. But those “free” visits under Aetna Direct would lower your HRA balance by $900! So, when comparing Aetna Direct to GEHA in this apples-to-apples example, have you “saved” $900 or just $45?

2) Routine in-network lab tests done outside of a doctors office cost the full contract rate until you have used up your Aetna Direct HRA balance and paid your full deductible. Only then is your liability limited to the 20% traditional co-insurance amount. Under GEHA Standard, routine in-network lab tests are free when you show your LabCard.

3) Once your Aetna Direct HRA is depleted, you are faced with a hefty deductible ($1500 per account for Self, $3000 for Family or Self+1). GEHA Standard’s much more modest deductible has a per-person limit ($350 per person up to an account total of $700 for Family or Self+1).

4) With its lower deductible, GEHA Standard’s traditional medical insurance coverage (15% co-insurance) kicks in sooner than Aetna Direct’s traditional medical insurance coverage (20% co-insurance).

5) Aetna Direct has no routine dental insurance benefits, just the ability to use your HRA for dental expenses. GEHA Standard, on the other hand, offers each enrollee two free exams, two free cleanings, up to $150 in x-rays, and modest but non-limited payments for fillings and extractions.

Important to Note: Once any covered family member enrolls in Medicare Parts A+B, all deductibles, co-pays and co-insurance for that person disappear under both Aetna Direct and GEHA Standard. But they remain in place for anyone else on the account. Given Aetna Direct’s large deductible, which is account-based, not person-based, there is no clear-cut advantage until all covered individuals have enrolled in Parts A+B. But once that happens, Aetna Direct’s HRA ($900 for Self, $1800 for Self+1) is then guaranteed to be used only to pay for stuff that would actually cost you that much dollar-for-dollar out of pocket under the competing GEHA plan. Stuff like Medicare premiums. That’s when Aetna Direct comes out ahead, but not until then.

Edited by user Wednesday, January 25, 2017 9:31:52 PM(UTC)  | Reason: Not specified

kap79  
#10 Posted : Friday, July 28, 2017 8:13:39 PM(UTC)

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We had GEHA and it was terrible. You need to look at more than just premiums and copays.
We ended up with a lot of denials for my infant son who had medical issues. Their non-covered items are significantly more than BCBS so you will get more surprises when you go to use it. Check it out side by side. Even Medicaid covers more. It didn't matter that we used in-network providers. The issue was not out of network providers. Things were denied and the providers sent us the bill instead. It wasn't hard to do. We hit at least 35 disputed claims in two months of care for my son.
The denial letters are vague and customer service is terrible. You are left not understanding what the issue is. Sometimes it can be successfully appealed after a long fight. They will not work with you or help you out.
They were great while we had low costs. They will screw you if you need to use the insurance.
Our providers say it is terrible insurance.
Sante123  
#11 Posted : Saturday, July 29, 2017 12:35:24 PM(UTC)
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kap79:

The maximum payment that providers receive for each procedure is negotiated in advance between the health network and participating providers. Some insurance plans run their own network, but not GEHA. It just follows the terms set by the networks it subscribes to. As upandup noted nine months ago, “It uses different networks in different states (most states are either Aetna or United HealthCare).” All insurance plans (including GEHA) do, however, control what kinds of services are covered and when, subject to requirements set by the OPM and other limitations spelled out in the plan brochure.

As you wrote, “We hit at least 35 disputed claims in two months of care for my son.” Presumably, your total number of claims was even more, of which 35 were disputed. That seems like an extraordinary number of separate claims in such a short time. Nevertheless, it sounds like hospitalization stays and imaging procedures may have been involved. Like many other plans, GEHA requires pre-certification of the medical necessity for hospital admissions, length of stay, certain surgeries and imaging procedures. When that process isn’t followed by the insured and his/her providers, GEHA charges a penalty and does its own analysis of medical necessity. Those services not deemed medically necessary are denied. If the insured appeals and gets the provider to supply better documentation, the claim gets paid. If the provider can’t fully document the claim, it doesn’t get paid. Isn’t that how it should be? As I said in a prior post, “if the plan brochure says that there are limits on certain kinds of care, or alternate benefit procedures…, don’t be surprised if that is exactly what happens.”

Some plans like BCBS Standard seem to afford greater leeway. But just remember that all insurer payouts come from current year premiums, and OPM dictates minimum ratios for total premiums and benefit payouts. This means if a plan charges a lot more, it has greater latitude. As I said in a prior post, “...don’t expect your low-cost plan to be as generous as one whose premiums cost 50-100% more.” It just so happens that the premiums for BCBS Standard Self+Family are double those of GEHA Standard Self+ Family. That means an extra $3,300 a year, every year, regardless of one’s health needs. You wrote that GEHA was “...great while we had low costs.” Now, it seems you prefer BCBS. But will you be comfortable paying an additional $33,000 in BCBS premiums over the next 10 years? Hard to say, isn’t it? Everyone has to make their own value calculation. Best of luck with yours.

PS: Since we’re swapping anecdotes, here’s mine. My wife and I had identical preventive care procedures performed at the same hospital, by the same doctor, in the same room, just one year apart. In both instances, the hospital’s “rack rate” charges were very high. As a Medicare enrollee, my claim resulted in a 100% combined coverage payout by Medicare and GEHA of just over $1,000. One year later, my wife's claim, which did not involve Medicare, followed the Aetna network’s negotiated contract rates. The actual 100% coverage payout was just shy of $12,000! [This is not a typo, but an actual 1200% more for the exact same service.] GEHA paid it without batting an eye.

Edited by user Tuesday, August 1, 2017 9:38:14 AM(UTC)  | Reason: Better sentence clarity in the last paragraph.

OUtside  
#12 Posted : Tuesday, August 1, 2017 12:17:39 PM(UTC)

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I think the point that more expensive plans are more generous raises lots of interesting questions. For example, are plans such as BC Standard and Basic one or two plans with respect to this distinction? If two plans, why are they both in the same brochure under the title '...Service Benefit Plan'? If the more expensive option is more generous with respect to this distinction, how likely is it both have the same satisfaction rating (which they do)? Similar questions about the GEHA Hi and Standard plans, in fact, the point that BC Standard requires a 50-100% higher premium than GEHA Standard applies similarly to BC Basic, much less expensive with the same satisfaction rating.

Before open season rolls around, I would like to see more discussion about this and, if possible, data to prove. It seems very important.
Sante123  
#13 Posted : Wednesday, August 2, 2017 12:04:16 AM(UTC)
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OUtside:

Each plan is actually separate, regardless of the plan sponsor brochure it’s displayed in. In the BCBS v GEHA context, BCBS Basic is cheaper than BCBS Standard, but still 36% more costly than GEHA Standard. And since Basic rarely deals with out-of-network providers, Blue Cross’ massive market leverage gives it a pricing advantage when dealing with in-network providers. Non-Medicare BCBS Basic members have to scrupulously avoid out-of-network providers, but if they do their experience can be nearly as good as Standard. Both BCBS and GEHA have very high retention rates year-over-year, so how else does one explain a reported difference in satisfaction levels? Well, it might be that folks who can afford higher premiums can also more easily afford unexpected medical expenses, and those who cannot (and gravitate to lower priced plans) are more likely to complain about being “let down” by their insurance carrier when faced with sudden out-of-pocket costs. It might also be that GEHA members have long memories and continue to gripe about claims processing delays which were common before its data systems were upgraded around 2014-15, but which are no longer such a bone of contention.

OPM reports “data” on FEHB plan quality and customer satisfaction. Checkbook Guide author Walton Francis has commented on the contours and the shortcoming of such data in chapter 9 of his annual guide. Makes for interesting, and headache-inducing, reading. I’ve never been able to figure out how any insurance plan can be held responsible for how medical care is delivered or the health outcomes derived from it. After all, the same providers usually belong to multiple networks, and the same networks often support multiple insurance plans. So who among them should get the credit (or blame) for the level of service? Why of course….the insurance companies! Just makes no sense.

However, there are three ratings that do, or should, relate directly to the plans themselves: Overall Plan Satisfaction, Claims Processing and Customer Service. The OPM ratings were listed as either Outstanding, Excellent, Good, Fair, Poor, or No Data. I compiled OPM’s reported findings for the sixteen separate plans from the six largest FEHB plan sponsors as found on OPM’s plan comparison website and in the Checkbook Guide to Federal Health Plans. I noticed the following: 1) To the extent that data was available, every plan’s Overall Satisfaction rating was higher than its ratings for Claims Processing or Customer Service. Go figure. 2) Within any given plan, more often than not the pricier Hi Option got the highest rating. 3) When counting all three categories, the highest rated plans were among those from the Letter Carriers and the Mail Handlers. 4) Of the plans offered by GEHA and BCBS, the one with the highest Overall Plan Satisfaction was GEHA Hi Option. 5) GEHA Standard’s ratings ranged from Fair to Poor, while BCBS Standard ranged from Excellent to Fair. However, there was no data for either BCBS Customer Service or for BCBS Basic Claims Processing. [SEE MY UPDATE IN POST #17]

How about disputed claims? Well, they were defined not as claims that got appealed to a plan for reconsideration, but claims that got appealed to OPM, presumably by those who weren’t satisfied with a plan’s final decision. It’s interesting to see which plans got appealed more often, but even more interesting to see which plans got upheld more often, and how that jibed (or didn’t) with a plan’s Claims Processing customer survey ratings. I found: 1) Northern California Kaiser Permanente had the lowest rate of disputed claims per 10,000 federal enrollees and was upheld every time, but members rated it only FAIR for claims processing! 2) GEHA’s combined disputed claims rate was five times the BCBS combined rate, but OPM upheld GEHA 82% of the time, while BCBS was upheld 79% of the time. The latter was rated Fair in Claims Processing while the former was rated Poor. 3) The NALC plans, whose combined disputed claims rate was three times the BCBS combined rate, and who got upheld by OPM just 66% of the time, received across-the-board Excellent Claims Processing ratings in the customer survey ratings. Once again, go figure. [SEE MY UPDATE IN POST #17]

So, if you’re looking for reliable hard data with which to compare FEHB plans, good luck. What’s available seems only slightly better than restaurant reviews on Yelp.

Edited by user Saturday, August 5, 2017 12:47:36 PM(UTC)  | Reason: Add Note re: POST #17.

OUtside  
#14 Posted : Thursday, August 3, 2017 9:43:44 AM(UTC)

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The two BCBS and two GEHA plans all have outstanding ratings. I understand the point about plans having to pay out vs premiums received ergo higher premiums means higher payouts, but if anything the two lower options having outstanding ratings don't reflect dissatisfaction ratings caused by denied coverages. I don't think the idea of denied coverage by lower premium plans has been discussed very much on this forum or for that matter in other sources such as Checkbook. If it's a real problem, I'm asking myself why not?

To avoid the issues he faced with his previous plan, poster above says to compare plans side by side, specifically with respect to this issue, what should we look for in making this comparison?

Edited by user Thursday, August 3, 2017 10:13:01 AM(UTC)  | Reason: Not specified

Sante123  
#15 Posted : Thursday, August 3, 2017 12:52:07 PM(UTC)
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OUtside:

1) Point of correction: [AS FAR AS THIS ITEM #1 IS CONCERNED, SEE MY UPDATE IN POST #17.]

a) GEHA Hi Option got OUTSTANDING for Overall Plan Satisfaction, and GOOD for both Claims Processing and Customer Service. GEHA Standard got FAIR for Overall Plan Satisfaction, and POOR for both Claims Processing and Customer Service. GEHA HDHP got GOOD for Overall Plan Satisfaction and POOR for both Claims Processing and Customer Service. Oddly enough, they all share the same cluster of networks and providers, and have the same plan administrator and claims reps. So what's the reason for the disparity? Who really knows? But I think that GEHA Hi Option's much higher premiums, which are higher than even BCBS Standard, gives it more latitude in handling discretionary and/or very expensive medical care. I use the term "generous", but really it's just a question of how much of a financial cushion is built into the plan.

b) BCBS Standard got EXCELLENT for Overall Plan Satisfaction, FAIR for Claims Processing and NO DATA for Customer Service. BCBS Basic got EXCELLENT for Overall Plan Satisfaction and NO DATA for both Claims Processing and Customer Service.

2) "Disputed claim" can mean that you disagree with the plan's initial determination and initiate discussions which may or may not end up with you receiving a favorable decision from the plan. It can also mean that you file an appeal of the plan's decision directly to OPM, which may or may not uphold your appeal. Finally, it may mean that your claim is denied and stays denied either because your provider didn't provide sufficient documentation on appeal or because you appealed to OPM and were not upheld. Am not sure which meaning kap79 intended.

3) Elsewhere, I think kap79 was referring to a line item side-by-side examination of what was covered in the relevant OPM plan brochures. However, that only goes so far. Most plans cover most of the same stuff. They may differ in the amount of the co-insurance percentage, the deductible, prescriptions, or the catastrophic maximum, but not on too many other items. The obvious coverage differences don't explain enough of the disparity in premium levels. However, plans also have language requiring pre-authorization for in-patient hospitalization and duration of stays, certain surgeries, certain imaging procedures, as well as for types of care that may not be medically necessary, or for which there may be valid lower-cost alternatives. The GEHA plans have this language, but surprisingly so do the BCBS plans. They probably all do.

4) ALL plans MUST deliver on ALL promised care as outlined in the plan brochures. If they don't, when necessary, OPM will make them pay if appeals are filed. So, when some folks say that Plan X "denied care", as if the plan cheated or was out to "screw" them, it is far more likely that what happened involved a financial outcome other than what the member wished. Beyond that, none of us can be sure what the substance of a complaint may be.

5) OPM requires that ALL FEHB plans spend at least 80-85% of each year's premiums on claim payouts or wellness initiatives. If they don't, they have to give the shortage back to the members the following year in the form of premium reductions or reductions of planned increases. Of course, if they pay out so much that they can't meet overhead expenses, they'll have to raise premiums or drop out of the FEHBP. Now, (very broadly speaking), all plans are committed to a similar level of health care coverage, and all plans must pay out a similar percentage of premiums. Yet some receive 25-50-100-200% more in premiums. So how do the high-priced plans spend all that extra money? Some things are obvious, like offering lower catastrophic maximum thresholds. Others may have lower deductibles. But the real test comes when the plan is on the hook for 100% of all costs (i.e, once the catastrophic max is met.) When that happens, the plan's liability can be enormous and must be managed to avoid jeopardizing access to care for all the average cost members. I think the degree of "care management" is how a low cost plan with moderate deductibles and catastrophic limits (like GEHA Standard) can stay affordable. It's also how a similar plan with far more premiums to spend can set itself apart by having a lighter touch in the care management department (like GEHA Hi Option or BCBS Standard.) Neither approach is fundamentally at odds with the language in the plan brochures, but there seems to be a difference in the way members perceive their customer experience. And I think that's the difference. Of course, YMMV.

Edited by user Saturday, August 5, 2017 1:48:52 PM(UTC)  | Reason: Add note re: POST #17.

OUtside  
#16 Posted : Friday, August 4, 2017 6:31:08 PM(UTC)

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The OPM web site has both GEHA and both BC options with outstanding ratings for customer service/overall plan satisfaction.

Based on this discussion, I think a subscriber with a serious or prolonged health situation should probably think more about enrolling in a high premium plan than perhaps he/she is accustomed to from reading discussions at this web site or elsewhere.
Sante123  
#17 Posted : Saturday, August 5, 2017 1:47:45 PM(UTC)
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Guess what? I just discovered that the OPM complaint rate data is nationwide, BUT the customer survey ratings are reported differently by zip code! You must enter your zip code at the OPM web site and at the Checkbook Guide site. However, neither site spells out that the ratings are only for the zip code you enter. Live and learn.

So what does this all mean? It means that none of us has the full picture when it comes to nationwide FEHB customer ratings data. This explains why OUtside and myself were citing different ratings for the same plans. Just for hell of it, I entered some zip codes in the East, West, North and South and found that GEHA HI option, and the BCBS plans got very high ratings almost everywhere, and that GEHA Standard seemed to get rated a lot better in the rest of the country than it did in the West. Overall, you could say that with FEHB plans, as in politics, everything is local. But, as OUtside and I were saying in slightly different ways, the higher premium plans in most every plan group could be a smart, no surprises choice for non-Medicare enrollees who expect to incur sudden high medical expenses or costly chronic care over a long period.
OUtside  
#18 Posted : Monday, August 7, 2017 8:30:58 PM(UTC)

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I raised the satisfaction ratings to try to begin to understand the magnitude of the problem. To approach that zip code by zip code doesn't seem realistic, maybe there is an overall rating available somewhere, but if Checkbook doesn't have it, probably not.

As far as 'non-Medicare enrollees' mentioned in the last post, Checkbook does provide financial estimates 'Most you could pay in a year,' but I don't recall any exceptions or a possible heads-up to such possibilities however remote.

Just for curiosity, I wonder what rating at OPM or Checkbook kap79's plan got in his zip code. Also, he said his providers said it is terrible insurance, making an interesting point for evaluating a plan, ask your providers what they think about it. I've never done that and just thought if they are in network, they are fine with it.

Sante123  
#19 Posted : Wednesday, August 16, 2017 9:16:24 PM(UTC)
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The OP asked for feedback about GEHA. Simple enough, but random anecdotes about situations with uncertain background facts offer very little for folks to verify or compare. This is a problem for ANYONE hoping to learn about ANY plan. I bet you've encountered plenty of posts that said something like "Plan X S*cks! Worst Plan Ever!!! Next year, I'm switching to Plan Y." You may even secretly share some of the opinions about how lousy Plan X is or how wonderful Plan Y must be. Well at least you might until you read the posts from the members of Plan Y!

I did just that by scouring the web for Yelp reviews of major health plans. Being a GEHA member, I looked at those reviews first and found that lots of folks didn't like GEHA. But I pressed on and found that lots of folks don't like Blue Cross either. And Kaiser Permanente, though it fared better, scored squarely in the mediocre range according to Yelp reviewers. Here are the Blue Cross results I found, listed by plan/location, number of reviews and average rating on scale of one to five: Anthem Blue Cross (CA), 29, 1; Blue Cross Blue Shield of Illinois, 115, 1.5; Empire Blue Cross Blue Shield (NY), 56, 1; Horizon Blue Cross Blue Shield (NJ), 79, 1; Blue Cross Blue Shield of Texas, 45, 1. And here are some of the Kaiser reviews I found: K-P (DC), 17, 2.5; K-P (So. Calif.), 174, 2.5; K-P (Nor. Calif.), 497, 3; K-P (Honolulu, HI), 180, 3.25, K-P (Denver, CO), 48, 2.5. Interesting, huh?

But that's not all. Reading those online posts and more over the years, I've found that many "reviewers" haven't a clue how insurance works, or what's in their plan, or why/how things didn't turn out as they hoped. In short, their opinions are uninformed, worthless. At the same time, I've encountered other folks on this site and elsewhere whose posts are insightful, subtle, well documented and restrained. In your own reading, it's up to you to separate the wheat from the chaff.

Now, back to GEHA. In the past, GEHA had its own in-house medical provider network, PPO USA, which the health plan side of the business stopped using at the end of 2012. After relying on an assortment of smaller local networks for a while, GEHA finally settled on a more stable mix including two of the largest networks: Aetna and United Healthcare. The transition from one model to the other was essentially completed for the 2016 and 2017 plan years. While this was going on, GEHA also overhauled its online presence, built a new payment processing infrastructure and digitized its EOB delivery system. Though the current situation is vastly improved, the intervening years gave some members a bumpy ride leading to delays, confusion and disappointment. Having joined in 2015, I experienced a bit of both eras. Anyone joining now will encounter a stable, modern plan environment.

Finally, do yourself a favor and keep in mind that there is no "GEHA network." There are five networks which GEHA uses. In 47 states and the District of Columbia, it's either United Healthcare PPO or Aetna Signature Administrators. The other three states are serviced by one of the remaining three networks. Medical providers sign up with healthcare networks, not individual insurance plans. So, when asking a provider about coverage, inquire about their preferred provider status in the network that operates where you live. If they are in that network, then they are in-network with GEHA, even if they have never heard of GEHA. This situation of a health plan being separate from the network it has a business relationship with is actually quite common within the FEHB. Some plans use the Cigna network; others use United Healthcare or Aetna. APWU even uses one network for its high option and a different one for its CDHP plan.

Edited by user Thursday, November 16, 2017 7:01:36 PM(UTC)  | Reason: Not specified

Sante123  
#20 Posted : Saturday, October 7, 2017 5:10:46 PM(UTC)
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GEHA’s 2018 enrollee-paid premium increases are once again well below the FEHB average rate of 6.1%. For simplicity’s sake, I looked at the monthly self+1 rates and found that GEHA Standard and GEHA HDHP both came in with 2% increases, while GEHA Hi Option’s increase was 2.6%.This compares favorably with BCBS Standard’s 7.1% and Aetna Direct’s 9.9%.

Edited by user Saturday, October 7, 2017 5:16:12 PM(UTC)  | Reason: Not specified

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