GEHA High Option?

Dec 1, 2016

  1. AfroPope
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    Hi folks,

    Met with one of my FE prospects today. I'll spare y'all the in betweens but she has two separate issues that need to be tended to.

    1. She has original Medicare and the GEHA high option plan because her husband was a federal employee. Her monthly premium is over $700 a month, but it covers 100% of costs. My thought here is that it's structured very much like a Plan F, however GEHA explicitly states on their website that you can have an advantage plan with it, suggesting to me that it's not a Med Supp. So what the heck is this thing??

    2. Her part D coverage is with ExpressScripts, who GEHA recently "stopped doing business with." She now has a bill for $10,000 in "adjustments and reversals" regarding her "secondary insurance," all of which are related to a Tier 5 drug she takes. I know I can get her a Part D plan that will give better coverage of that drug, but is she totally SOL on those $10k in bills?

    Thanks!
     
  2. TwoCents
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    A quick search shows that the move from ExpressScripts to CVS took place at the end of 2014. Not what I'd call recent. This FAQ https://www.geha.com/~/media/Files/...rescriptions/CVS_caremark_2015_FAQs.pdf?la=en says her specialty prescriptions should have been transferred. If that didn't happen, she should fight it. At the very least I would think subrogation should occur and the claims just need to be submitted to CVS for processing.
     
  3. AfroPope
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    You're correct on that timeline, I went back over my notes and she had mentioned that it was 2014 as well. Great news that she may have some recourse!

    Can anyone sort out the GEHA thing for me? It sounds like it's just a secondary private insurance and that she'd be far better suited with a plan G. Paging Rick and other Medicare folks, I don't get out of the FE forums much these days.
     
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