This article compares the Government Employees Health Association (GEHA) Standard Plan to its 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 runs from November 10 through December 8; we have several weeks to decide whether to stay the course or switch to another, potentially lower-cost plan that offers the benefits and services we need. Today, with the rising cost of everything, it is an essential and time-consuming task.
FEHB Medicare Advantage Plans
Many Federal Employee’s Health Benefit (FEHB) and Postal Service Health Benefit (PSHB) plans now offer a Medicare Advantage (MA) option. They provide significant savings and expanded benefits to federal employees and annuitants enrolled in Medicare.
I’ve been a Government Employees Health Association (GEHA) Standard plan member for the past 14 years; they have provided exceptional service and low-cost benefits without fail. Their MA Standard and High option plans offer additional attractive benefits, including a Medicare Part B subsidy.
The Self + One GEHA Standard Option
There are two GEHA Medicare Advantage plans under the FEHB program this year: a Standard and a High option, both managed by UnitedHealthcare, 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 $404.11; the High option costs $938.06.
Actually, GEHA’s Standard premium is among the lowest available, and they offer comprehensive coverage and excellent service overall. There aren’t any additional premiums required when you opt for their Medicare Advantage offerings. Plus, both plans provide a Part B monthly subsidy, $75 for the Standard Plan and $100 for the 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 per month for both you and your spouse, depending on the plan you enroll in.
In other words, if you file a joint tax return with a modified adjusted gross income of less than or equal to $218,000 in 2024, your Part B premium would be $206.50 for each of you next year. If you are enrolled in the Standard GEHA MA plan, Social Security will reduce your premium by $75 to $131.50, and your Social Security check will increase by $75 for both you and your spouse!
Note: Modified Adjusted Gross Income (MAGI) is determined for 2026 from your 2024 tax return. In most cases, the IRS won’t have your 2025 MAGI until after April 15th of 2026, when taxes are due. Your 2025 income will be used to determine your MAGI for 2027.
According to GEHA, “Enrollment in their MA plans 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.
GEHA Standard MA Advantages
The following list highlights some of the significant benefits of the FEHB MA Standard option:
- The MA plan provides a $75 Part B monthly premium subsidy
- Free gym membership and other RenewActive® benefits
- $0 copays on covered medical services and other benefits.
- Over-the-counter item allowance of $40 per quarter
- Eliminates the annual Medical out-of-pocket maximum
- Unlimited speech and occupational therapy visits
- No copayment for durable medical equipment
- Foreign travel benefit
- $2,500 hearing aid allowance, limited to UnitedHealthcare hearing network providers
To clarify, the GEHA MA option is a national Preferred Provider Organization (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.
It’s also advisable to keep your original Medicare cards in a safe place in case you decide to cancel your MA plan and return to the FEHB / PSHB and Original Medicare.
Prescription Drug Tiers
Once you elect an MA plan (Medicare Part C), 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 signing up for an 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 choose to re-enroll down the road.
Significant prescription cost savings
If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you only pay the exact price, not the higher cost-sharing amount. 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 apply to drugs 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.
Check the cost of your prescriptions for all GEHA plans. Review their Medicare MA plan brochure for prescription drug costs.
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).
Most required to pay an IRMAA will be in the first bracket, those filing an individual tax return with a MAGI of greater than $109,000 but less than or equal to $137,000, or those filing a joint return with a MAGI greater than $218,000 but less than or equal to $274,000.
Once you move to a bracket that requires an IRMAA, those enrolled in an MA plan would also pay Part D IRMAA premiums. However, for those in the first bracket, that would only amount to $14.50. Let’s work up the numbers.
The Numbers Game with the MA Option
For this analysis, a couple is filing a joint return with a MAGI of $230,000. They are in the first IRMAA bracket, and their premiums will be as follows:
- $404.11 – GEHA Standard FEHB for Self Plus One
- $428.20 – Part B premium $206.50 plus an IRMAA of $82.60 ($289.10). Each person will pay $289.10. After the $75 Part B subsidy is applied, $214.10 would be deducted from each of their Social Security checks each month.
- $29.00 – Part D premium, the IRMAA, $14.50 for each person. The $14.50 will also be deducted from each of your Social Security checks monthly.
The couple’s total premiums will be $1,011.31 without the Part B subsidies. The adjusted amount, after Medicare Part B subsidies of $75 per member per month, reduces total premiums to $861.31. Social Security will reduce your Part B premium by this subsidy, therefore increasing each of your Social Security checks by $75.
In this example, the MA subsidies reduced the couple’s total monthly premium by $150. Then factor in your lower prescription drug costs under an MA plan, along with the additional benefits — such as the $40 over-the-counter item allowance, a free gym membership, and the elimination of the annual medical out-of-pocket maximum — and there is a lot to consider.
Compare Plans
Use OPM’s FEHB Plan Comparison Tool and Consumers’ Checkbook 2026 Guide to Health Plans to find the best FEHB / PSHB plan for your needs. The Consumers’ Checkbook Guide is available in print and online formats.
Order the Checkbook’s 2026 guide and save 20% by entering promo code FEDRETIRE at checkout. The online and print Guide is available on November 10.
Note: Many agencies, including the USPS, provide free access to Checkbook’s 2026 guide on their intranet, Employee Express, or through designated agency computers. Check whether your agency offers this free service.
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, including the premium and 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.
Use these two excellent tools to drill down and find the plan that best suits your personal situation. Review individual FEHB / FHEB brochures; they provide the plan’s official statement of benefits.
Summary
Review Section 2 (Changes) in the provider’s Benefit Guide for the plan you are currently enrolled in to ensure the services you count on aren’t negatively impacted by the 2026 changes.
When reviewing these changes and concurrently enrolled in traditional Medicare, your FEHB plan covers most copays and coinsurance when Medicare is your primary provider. Oftentimes, the changes listed in Section 2 relate to copayments and coinsurance, which are covered under Medicare.
If you are considering moving to an MA plan, you won’t find a specific plan brochure like you will for the FEHB and PSHB providers. You must visit the provider’s website, review their MA plans online, and call their help line to ask questions and to sign up.
I’ve been hesitant to switch to an MA plan since they were first introduced under the FEHB umbrella several years ago. Fortunately, you can opt out of the GEHA MA program at any time and revert to your original FEHB plan and Traditional Medicare if desired.
There are still issues with referrals required for services such as MRIs and various tests under MA plans. Plus, there may not be service providers in your immediate area that accept your MA plan.
Another consideration is that retirees’ income can change each year due to retirement plan RMDs, increased interest and dividend income, and unanticipated capital gains, which 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.
Contact the FEHB / PSHB provider’s help line for clarification and to sign up. They are generally available from 8 a.m. to 8 p.m. local times, 7 days a week during Open Season.
When you call, be prepared to answer questions to confirm your identity and determine which MA plan you are eligible to enroll in.
