GEHA Insurance Plans for Federal Employees and Retirees

GEHA (Government Employees Health Association) offers five medical plans through the Federal Employees Health Benefits (FEHB) Program for 2026, along with separate dental and vision coverage. If you’re a civilian federal employee, a federal retiree, or an eligible family member, GEHA insurance plans for federal employees and retirees give you a range of choices from a low-premium high-deductible option to a comprehensive plan built for retirees coordinating with Medicare.¹

The Five GEHA Medical Plans for 2026

GEHA’s FEHB lineup includes Elevate, Elevate Plus, HDHP, Standard, and High. Each strikes a different balance between what you pay upfront and what you pay when you use care.¹

Elevate. Built around low copays for the services people use most: primary care, specialists, and generic prescriptions.
Elevate Plus. In-network only, with $0 telehealth visits, $30 primary care copays, and $15 generic drug copays. Self-only premiums run $205.13 biweekly for active employees.²
HDHP. A high-deductible plan with lower premiums that qualifies for a Health Savings Account. The 2026 in-network deductible is $1,800 for self-only and $3,600 for family.³
Standard. The mid-tier option, with self-only biweekly premiums of $86.75 for active employees.⁴
High. The most comprehensive option, with the broadest brand-name and specialty prescription coverage and the richest benefits for retirees coordinating with Medicare.

One difference matters when you’re choosing: Elevate Plus does not cover out-of-network services at all.² The other four plans pay for out-of-network care, but at a much higher cost to you.

What’s Covered

All five plans cover preventive care at 100% when you use an in-network provider, in line with Affordable Care Act rules. That includes annual check-ups, screenings, and immunizations, and there’s no copay even if you haven’t met the deductible.⁵

Mental health services are covered across every plan. Under Elevate Plus, for example, in-network mental health office visits carry a $30 copay, and telehealth mental health visits through MDLIVE cost nothing.²

Hospitalization and emergency care are covered on every plan, but cost-sharing varies. The HDHP requires you to meet your deductible before most cost-sharing applies. Elevate Plus charges 20% coinsurance for inpatient hospital stays after a $200 individual deductible. GEHA requires preauthorization for non-emergency hospital admissions, and skipping that step can bring a penalty. Emergencies are exempt.⁶

Out-of-Pocket Maximums

Every plan caps your annual spending. Once you hit the cap, GEHA pays 100% of covered services for the rest of the year. For in-network care in 2026:

Elevate Plus: $7,000 self-only / $14,000 family.²
High: $7,500 self-only / $15,000 family.
Standard: $8,000 self-only / $16,000 family.⁷

Out-of-network limits are much steeper. The High and Standard plans both cap out-of-network spending at $20,000 self-only and $40,000 family.⁷ Under family enrollment, no single person has to pay more than the self-only cap before full coverage kicks in.

Prescription Drug Costs

Drug cost-sharing is tiered, and the amounts differ by plan. Under Standard, a 30-day retail generic costs $10 and a 90-day mail-order supply costs $25.⁸ Under Elevate Plus, the same generic runs $15 retail and $20 mail-order.²

Specialty drugs cost more. On the High plan, generic and preferred specialty drugs run 25% coinsurance up to $350, and non-preferred specialty drugs run 40% up to $400.⁹ On Elevate Plus, specialty coinsurance runs 40% to 50% depending on tier, with per-prescription caps of $700 for preferred medications.²

If you pick a brand-name drug when a generic equivalent is available, you’ll pay the generic copay plus the price difference. Mail order is available across all plans and usually costs less for maintenance medications.

HDHP Enrollees: HSA or HRA Contributions

Enroll in the HDHP and you can pair it with either a Health Savings Account or a Health Reimbursement Arrangement. GEHA makes a monthly premium pass-through contribution to either account, totaling $1,000 per year for self-only coverage and $2,000 for self plus one or family.¹⁰ Those dollars count toward the IRS annual HSA maximum.

For 2026, the IRS HSA contribution limit is $4,400 for self-only and $8,750 for family coverage.¹¹ You can add your own money up to those caps after GEHA’s pass-through. HSA balances roll over year to year and belong to you even if you change plans or leave federal service. HRA funds are controlled by GEHA and don’t roll over the same way.

Provider Networks

GEHA uses UnitedHealthcare networks. Elevate and Elevate Plus use UnitedHealthcare Choice Plus in all 50 states and Washington, D.C. HDHP, Standard, and High also use Choice Plus in most states, but in California they use UnitedHealthcare Select Plus instead.¹²

Staying in-network makes a real difference. Out-of-network reimbursements under Standard and High are based on GEHA’s allowable charges, not the provider’s full billed amount, so you can end up owing the balance. Elevate Plus goes further: no out-of-network coverage at all.²

Dental and Vision Coverage

GEHA offers dental insurance through Connection Dental Federal, part of the Federal Employees Dental and Vision Insurance Program (FEDVIP). It is separate from the medical plans and comes in a High Option and a Standard Option.

High Option has no deductible, unlimited annual benefits for basic and intermediate services, and a $3,500 lifetime orthodontic maximum. In-network, you pay nothing for basic services, 20% for intermediate, and 50% for major services like crowns. Standard Option has lower premiums but a $2,500 annual in-network benefit maximum, a $75 out-of-network deductible, and higher coinsurance: 45% intermediate and 65% major.¹³

Vision coverage runs through Connection Vision, powered by EyeMed. It’s a discount program rather than traditional insurance. Buy a complete pair of eyeglasses from an in-network provider and you get 60% off retail frame price. Contact lens discounts are smaller, with members paying 85% of retail for conventional lenses. There’s no annual limit on the number of discounted purchases.¹⁴

Wellness Rewards

Every plan rewards healthy behaviors, but the dollar amount depends on which plan you pick. Members on Elevate or Elevate Plus can earn up to $500 per person per year through Wellness Pays, up to $1,000 total for a subscriber and covered spouse. Members on HDHP, Standard, or High can earn up to $250 per person per year through Health Rewards, up to $500 total.¹⁵

All medical plan members can also access Connection Fitness through Active&Fit Direct, with discounted memberships at over 12,200 fitness centers and thousands of digital workout videos for a small monthly fee.

Who Can Enroll

GEHA’s FEHB plans are open to civilian federal employees, federal retirees (annuitants), and their eligible family members.¹⁶ Family coverage extends to spouses and dependent children up to age 26, including biological, step, adopted, and foster children. Children 26 or older who are incapable of self-support may also qualify if the condition began before age 26.

Active-duty military are not eligible for FEHB, though retired military members who hold a qualifying civilian federal position can enroll. Temporary and seasonal employees generally can’t enroll unless their position provides FEHB access. Part-time employees may qualify if their agency participates, though the government’s share of the premium may be different.

Retirees

To carry FEHB coverage into retirement, you must be entitled to an immediate annuity and must have been continuously enrolled in an FEHB plan (or covered as a family member) for the five years right before your annuity starts. If you had fewer than five years of service since your first chance to enroll, the requirement is the full period of service instead. Time covered under TRICARE counts toward the five years as long as you were enrolled in FEHB at the time of retirement.¹⁶

Postal Workers

As of January 1, 2025, postal employees and postal retirees can no longer enroll in FEHB plans. They must instead enroll under the Postal Service Health Benefits (PSHB) Program.¹⁷ GEHA offers three separate PSHB plans for postal workers: an HDHP, a Standard option, and a High option.¹⁸ If a postal worker is covered under a family member’s FEHB enrollment that isn’t through the Postal Service, that coverage can continue.

How to Enroll and What Plans Cost

Enrollment happens during FEHB Open Season, which runs from mid-November to mid-December each year. Changes take effect January 1.¹⁹ Outside Open Season, you can only enroll or switch after a qualifying life event such as marriage, a birth, or a change in employment status.

Active employees enroll through their agency’s benefits system, such as GRB Platform.²⁰ Retirees make changes through OPM’s retirement services. You pick both a coverage tier (Self Only, Self Plus One, or Self and Family) and one of GEHA’s five plans.

Premiums come out of paychecks for active employees or annuity payments for retirees. Active employees generally pay premiums pre-tax through Premium Conversion, which reduces federal income tax and FICA taxes; enrollment in Premium Conversion is automatic unless you waive it.²¹²²

For a sense of 2026 pricing, active-employee biweekly premiums on Standard are $86.75 self-only, $186.51 self plus one, and $231.45 self and family.⁴ Elevate Plus runs $205.13 biweekly self-only.² Retiree premiums are monthly rather than biweekly: Standard costs $187.95 per month self-only. Rates differ for enrollees in certain special categories.

Coordinating With Medicare

For retirees enrolled in both Medicare and GEHA, the two work together to reduce out-of-pocket costs. GEHA’s Standard and High plans provide 100% coverage for covered Medicare services when you have Medicare Parts A and B, picking up the deductibles, copays, and coinsurance Medicare leaves behind.²³ The High plan also offers a $1,000 annual reimbursement toward Medicare Part B premiums. Members can upgrade Standard or High to GEHA Medicare Advantage at no additional premium cost, which adds features like $0 medical copays and no deductible.²⁴

If you have coverage from more than one source, coordination of benefits rules decide which plan pays first. When a federal employee also has coverage through a spouse’s employer plan, one plan is primary and the other secondary, with the secondary picking up eligible costs the primary didn’t cover.

Appealing a Denied Claim

If GEHA denies a claim or coverage request, the appeal process has three levels.²⁵ File your initial appeal to GEHA within six months of the denial, by mail, fax, or online, and include your member ID, date of service, claim number, and supporting documents. GEHA typically reviews post-service appeals within 30 days.

If GEHA upholds the denial, you can ask for a reconsideration, where GEHA reviews all available information and may consult a healthcare professional. If you still disagree, you can appeal to the Office of Personnel Management, which conducts an independent review and issues a final decision (or a status update) within 60 days. Your only remaining option after OPM is a lawsuit against OPM in federal court, and the deadline to file is December 31 of the third year after the year you received the disputed services.²⁵

1
Government Employees Health Association. Overview of G.E.H.A’s FEHB Health Plans for 2026
2
Government Employees Health Association. FEHB Elevate Plus Health 2026
3
Government Employees Health Association. 2026 G.E.H.A FEHB HDHP Summary of Benefits and Coverage
4
Government Employees Health Association. FEHB Standard 2026
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HealthCare.gov. Preventive Health Services
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Government Employees Health Association. G.E.H.A Preauthorization FAQs
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Government Employees Health Association. 2026 G.E.H.A FEHB High and Standard Options Medical Plan Brochure
8
Government Employees Health Association. 2026 G.E.H.A FEHB Standard Option Summary of Benefits and Coverage
9
Government Employees Health Association. 2026 G.E.H.A FEHB High Option Summary of Benefits and Coverage
10
GEHA. 2026 HSA and HRA FAQs
11
Internal Revenue Service. Notice 26-05 HSA Inflation Adjustments
12
Government Employees Health Association. GEHA’s Medical Network Providers
13
GEHA. 2026 G.E.H.A Dental Plan Brochure
14
Government Employees Health Association. Vision Coverage for G.E.H.A Members
15
GEHA Health Plans. Invested in Our Members’ Health and Well-being
16
U.S. Office of Personnel Management. Eligibility
17
U.S. Office of Personnel Management. Postal Service Health Benefits (PSHB) Program
18
Government Employees Health Association. Overview of G.E.H.A’s PSHB Postal Health Plans for 2026
19
U.S. Office of Personnel Management. Open Season
20
U.S. Army Financial Management Command. Federal Employees Health Benefits Open Season Info
21
U.S. Office of Personnel Management. Premium Conversion
22
U.S. Office of Personnel Management. Federal Employees Receiving Premium Conversion Tax Benefits
23
GEHA. 2026 GEHA Medicare Benefits Guide
24
Government Employees Health Association. GEHA Medicare Plans
25
Government Employees Health Association. G.E.H.A Appeal Process and Disputed Claims FAQs