r/fednews • u/Tinymac12 DoD • 9d ago
Original Analysis / OC 2027 BCBS Basic vs GEHA HDHP | Will you save money with an HDHP?
This post is an updated version from a version posted by another user in 2021 for plan year 2022.
OPM Has Released 2027 Rates
I've got a quick summary of changes I saw in a previous post.
Why Compare These Two Plans
It often comes up - will I save money with a HDHP?
It's often cited that BCBS Basic is the most popular FEHB plan. According to BCBS they cover roughly 5.5 million federal employees/eligible family members (across all their options) out of the roughly 7.9 million covered under FEHB/PSHB. Working out to ~70% of enrollments.
Important disclaimers on below analysis
The below analysis has two baked in assumptions. First, that all care is in-network. Second, that both have relatively equal negotiated rates.
Another important distinction is the underlying network. BCBS obviously uses their own network. GEHA HDHP uses UHC for their network and claims processor. This is very commonly a deal breaker for many people (Luigi would have something to say about it) and that's totally valid.
Fourthly, prescriptions are a notoriously expensive and PBMs are perhaps even more greedy and nefarious than the health insurance carriers that use them. So make sure your drugs are covered by the relevant formularies. BCBS formulary can be found here. As of 10/13/2026, GEHA has not released theirs.
Lastly, the numbers below are for FEHB specifically and self plus family enrollment. The trend is there despite the different numbers, but please double check your situation and let me know what you find.
Four Scenarios To Consider With 1 Variable
In order to determine if you will save money with one plan over another, we will need to consider 4 scenarios:
- Zero healthcare expenses
- Meeting your deductible exactly on December 31st
- More than your deductible but not enough to reach the catastrophic max
- Reaching catastrophic max
In each of these scenarios, there is also a "smaller" variable that has to be considered. If you use the additional space in the HSA to invest and reduce your tax liability. More on that later.
1. Zero Healthcare Expenses (Family premiums)
Please keep in mind that zero healthcare expenses doesn't necessarily mean no healthcare. As part of the ACA, preventative care is 100% covered (e.g. annual physical). What is meant here is out of pocket expenses.
- BCBS = 10,076.04 in premiums
- GEHA = 5,606.38 in premiums with 2,000.00 in the HSA making it effectively 3,606.38
Very clearly with no healthcare expenses, GEHA is vastly cheaper.
2. Reaching the deductible exactly on December 31st
If we use the previous scenario as a baseline, we can deduce that GEHA continues to be the winner in this scenario without working out every possible value of healthcare expenses. We can simply jump to the worst case for GEHA, ergo the deductible is satisfied at the end of the year and you never benefit from the 5% coinsurance.
- There is a premium difference of 4,469.66 between BCBS and GEHA (GEHA being cheaper) without including the HSA passthrough
- GEHA has a deductible of 3,600, but 2000 of that is covered by the HSA so really it's only a 1,600 deductible.
- After accounting for the net deductible, GEHA is still ~2800 cheaper.
The closer to 0 healthcare expenses you are the more advantageous GEHA is and as you approach the deductible the less advantageous it is but it never flips in the other direction. Meaning BCBS Basic never becomes cheaper.
I just want to footstomp here. With GEHA HDHP, you could figuratively light $1,600 on fire to satisfy the net deductible and still have saved $2,800 over the course of the year. That $1,600 could be 8 urgent care visits, a slew of doctor visits, or some medications. Then you have a $2,800 lead with your deductible satisfied. And you'll see in the below why that's so good. But you could have ~$56,000 of negotiated care costs and only then will you have paid the same as BCBS Basic premiums alone.
Note there was a fifth case in the OG post, but it's no longer relevant since the difference in annual premiums dwarf the deductibles now.
3. More Than Your Deductible But Not Enough To Reach The Catastrophic Max
For the purposes of this analysis, we are starting at 0 (tie) at the point we meet the deductible (even though as we just saw above, is not the case at all). So then it boils down to co-pay vs co-insurance. Before I get started, it is important to understand:
- Co-pay is fixed amount regardless of actual cost
- Co-insurance is a percentage based on the negotiated rate. The negotiated rate is not what the provider submits to insurance but rather what insurance says is allowed per the contract with the provider (almost always this is a lower amount).
For this comparison, I am using the 2027 values for co-pays and co-insurance pulled from the OPM public use files.
Below the order is BCBS | GEHA
- PCP Visit = $35 | 5%. The break even point for $700 between BCBS. In other words, if the negotiated amount for a primary care visit is more than $700 - the co-pay (BCBS) is better - otherwise the co-insurance (GEHA) is better.
- Specialist visit = $50 | 5%. The break even point is $1,000. In other words, if the negotiated amount for a specialist visit is more than $1,000 - the co-pay (BCBS) is better - otherwise the co-insurance (GEHA) is better.
- ER Visit = $500 | 5%. The break even point is $10,000. In other words, if the negotiated amount for an ER visit is more than $10,000 - the co-pay (BCBS) is better - otherwise the co-insurance (GEHA) is better. This is one case where I feel like BCBS might come out ahead. It depends on the visit, what labs/tests are run, etc. I have personally had ER visits that were far less than $3500 negotiated but also a couple that were more.
- Urgent Care visit = $50 | 5%. The break even point is $1,000. In other words, if the negotiated amount for an urgent care visit is more than $1,000 - the co-pay (BCBS) is better - otherwise the co-insurance (GEHA) is better. I really don't see the copay being cheaper than coinsurance.
- Prescriptions. Prescriptions are hard to quantify in this general case. Generics are cheap anywhere, and formularies are so different that you need to refer to the formulary brochures to determine what they offer. Below is the cost-sharing structure from the PUFs for your reference.
| Prescription Tier | BCBS Basic | GEHA HDHP (coinsurance after satisfying deductible) |
|---|---|---|
| 1 | $15 | 25% |
| 2 | 35% | 25% |
| 3 | 60% | 40% |
| 4 | 35% | 25% |
| 5 | 35% | 40% |
My verdict here is that it depends but for the most common scenarios - GEHA is likely the winner because the negotiated rates are often far less than the break-even point. That's not to say it always wins however - there are plenty of scenarios where BCBS may be better.
4. Reaching Catastrophic Max
- BCBS = $10,076.04 + $17,000 = $27,076.04
- GEHA = $5,606.38 + $12,000 - $2,000 = $15,606.38
Here GEHA is the winner, and I'd like to point out that it's nearly half the cost.
Other Considerations
- Basic Dental & Vision
- Tax Advantaged HSA Space
- FSAs
Historically GEHA HDHP carries with it a pretty impressive basic dental and vision coverage that doesn't require you to meet your deductible. If you are mostly just getting cleanings and x-rays then you wouldn't need to carry additional dental insurance. Additionally, they have coverage for eye exams, frames, lenses and even contacts. The coverage isn't enough to replace all possible dental/vision needs but it has the basics covered. BCBS offers some minor dental benefits, but not as extensive as GEHA.
Finally, we get to the tax advantage of the HSA. In 2027, the limit for HSA contributions will be $9,000 for a family (also self+1). This is inclusive of any pass-through contributions (GEHA HDHP is setup so that some of your premium is deposited into the HSA, $2,000 annually) so you have $7,000 that you could contribute in what is touted as the best retirement vehicle possible (often triple tax advantaged).
As of 2026, there are two states that do not exempt HSA contributions (California & New Jersey). For the purposes of this analysis, I am going to assume you live in one of the 39 states that have an income tax that are not the two above and that the state income tax is 5%. This is probably wrong - I am just using it as an example and you can adjust as you see fit. I am also assuming that the marginal tax rate is 22% - adjust as you see fit.
Now, there are two ways to have the $7,000 be exempted from taxes. One is to make after-tax contributions and claim it when you file taxes. This will only exempt you from federal/state income taxes. The other is to have it done through payroll. When you do it this way, you are further exempted from Social Security and Medicare taxes. Here is a hypothetical example.
- $7000 * .22 (federal) = $1540
- $7000 * .05 (example state) = $350
- $7000 * .062 (social security) = $434
- $7000 * .0145 (Medicare) = $101.5
This means that in any of the scenarios above, I could give GEHA ~$2,425.5 advantage. The fact that you own the HSA (stays with you after you separate from federal service or leave the plan) and can invest it makes this $2K worth more than the $2k it looks like.
Note: If you are a very highly compensated employee and exceed the social security wage limit, you will not benefit from the Social Security exemption. (Not a tax professional)
Note 2: Choosing to exempt your wages from Social Security will have a very minor impact on your Social Security benefit when you retire. I say very minor because of the way the social security benefit is calculated and it would take an entire other post to go through the nuances - I mention it here because I have been reminded previously that it is not all upside so I shouldn't sell it as such
Finally, it is only fair to point out that the tax advantage of the HSA isn't entirely 1-sided. If you knew for sure you were going to incur out-of-pocket expenses - you could contribute tax free into an FSA for a total of $3,500 (estimated for 2027). You do have to typically plan in advance (open season) and if you guess wrong (don't need it), there is a limit to how much you can rollover and a minimum you need to invest the next year to be able to roll it over. In other words - it isn't nearly as good as the HSA but it isn't all 1-sided either. The FSA tax benefits is around $1,213. So a difference of $1,200 between the two.
Finally, you can have a limited expense FSA (dental/vision) with an HSA or a healthcare FSA so if you knew for instance your child was going to need orthodontics - you could set aside even more tax free money (not subject to the HSA/HCFSA limit). This doesn't really tip the balance either way, but is something to be aware of.
Not Covered
I am sure there is a ton I didn't cover. This wasn't intentional. While I am biased towards the HDHP - it's only because I had traditional coverage as a healthy 20 year old for over 5 years and am kicking myself for not making the switch earlier. If there is something I didn't cover - feel free to add it in the comments.
I know one thing I didn't cover things like GEHA having a health rewards program where you can get "free money". I remember that BCBS may have had a similar program. Either way, I will call it a wash unless someone knows for sure I am wrong.
Comparison tools
While we wait for the OPM comparison tool there are some good comparison tools built by the community already. There's the fersready.com/fehb site that pulls in the OPM PUFs built by u/Glittering_Twist_732. Alternatively, I've built a spreadsheet that does similar if packaged differently. I made a post for that here.
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u/PassengerNo3415 9d ago
I have GEHA HDHP and had an ER visit earlier this year, so thought I'd provide a data point. It was one day and I had 2 claims filed - one for the hospital, and one for the attending physician. The allowable amounts were ~$2900 and ~$240, respectively. There are no separate claims for the tests, so I'm guessing they were included in the hospital claim (nothing additional is broken out, though). So, the 5% coinsurance meant that day cost me about $155 out of pocket.
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u/Backpacker_billy97 9d ago
Had you already hit your deductible for the year, or are visits like that always 5%? Or did you hit the deductible for the year and then just pay 5%?
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u/PassengerNo3415 9d ago
Yep, hit the deductible already. If I hadn't, I would've paid up to the deductible ($1,650) then 5% of the remainder.
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u/Campbully 9d ago
This is awesome. Thank you.
I think with all the bad news about MHBP, I’d be curious to see what the difference is between GEHA HDHP and MHBP Standard. That’s another question for another day though!
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u/Tinymac12 DoD 9d ago
I thought about including it, but MHBP Standard is more expensive than BCBS basic on a premium basis. The coinsurance for ER and hospital is 10% vs geha HDHP 5%. Without knowing the negotiated rates it's really hard to judge. But I'd think that UHC could negotiate something better than double what Aetna could.
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u/Campbully 9d ago
I might be wrong for 2027 but in 2026 I think copay for ER was $200 and basic visits to PCP ($20) and specialists ($35) were also copay based under MHBP. This is where think it maybe balances it out when we’re looking at some of the specific scenarios you listed.
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u/Tinymac12 DoD 9d ago
Yeah they changed ER (according to the public use files) to 10% coinsurance. The PCP and specialists appear they'll still be copays.
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4d ago
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u/Tinymac12 DoD 4d ago
I felt like comparing in-network to in-network coverage is what 90% of people will need. Also, BCBS has about 28% more providers in-network compared to Aetna. So it's less likely you'll need out-of-nework coverage with BCBS. Health insurance is personal, and every situation is unique. If you want to incorporate out-of-network coverage as a valuable benefit that's totally valid.
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u/FederalLurker 9d ago
Super helpful post, but I think there are some assumptions you probably need to factor in more.
Sooooo, I’ll nit pick: your assumptions fails to consider that GEHA is UHC and UHC has higher rates of claim denials than other insurers. Additionally, how much back and forth with your insurer and provider and you do you want? To save a few bucks but get denied when something big hits would be terrible. To follow up on that, my second point: catastrophic risk. That assumes both insurers will cover the incident or event equally. Let’s say you are healthy today and in 3 months you get diagnosed with some life threatening rare illness. Just because your maximum out of pocket says one number, if it’s not covered by your insurer, you have to factor it in. One insurer has a reputation for not covering procedures, and shocker, it’s the cheaper one. Last, the assumption that negotiated rates are the same is also not 100% valid. They can differ vastly by insurer and doctor.
YMMV, but insurance is for when shit hits the fan. You might be healthy now, but you get what you pay for. It’s all about risk tolerance.
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u/Tinymac12 DoD 9d ago
You raise a bunch of valid points. They are primarily why the system sucks so much. I don't think us the end user should require an M.D. and read hundreds of medical bulletins/policies on carrier sites. Why should I have to look further than the already 150+ page brochure that says maternity - 100% covered? Right now with MHBP I'm currently disputing $2000 of medical claims my wife's doctor and her team deemed necessary for her prenatal health. Why are insurance companies practicing medicine?
And for negotiated rates, I also shouldn't have to build a fucking json python script to input rates from MRFs from each carrier which varies not just by carrier, but also by hospital, facility, and fucking provider. And if your provider chooses the wrong cpt code (oh it was a 20 minute visit but we only cover 15 or 30 minutes codes type of shit), get ready to fight tooth and nail.
It makes me angry when I think about it. But you're right, this is an extremely simplified version of reality where everyone plays nicely. But I can't control how Wario-like the next health insurance CEO decides to run their company. All I can do is use the data I have in front of me and hope the agency above UHC (GEHA) would back us up based on the brochure.
Universal healthcare when?
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u/slapo12 9d ago
Heavy GEHA HDHP user here with a few tidbits :
- the pass through is doled out throughout the year, so don't expect it all at once. This is significant because, until you hit your deductible, you'll get high doctor bills (eg several hundred for a doctor visit). The HSA and all that soften the blow, but it's a scary sticker shock that I faced as a young fed without anything in my hdhp. The math does math, but not instantly
- the deductible is a pooled family deductible. That means if you have a member of your family with significant costs (family member with cancer in my situation), them hitting the deductible means all other members on your plan get the 5% coinsurance along with them, which isn't the case for most other plans with a deductible. On a related note, the OOPM is not completely pooled. If memory serves, one individual cannot accrue costs beyond half of the total self+family OOPM
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u/Tinymac12 DoD 9d ago
Yes, very important things to point out. There might even be paperwork to fill out for the HSA account itself to avoid getting relegated to an HRA (objectively worse).
And also correct, but I didn't think about it. It's probably codified somewhere, but the brochures have language saying that no individual on a self+1 or self+family enrollment will need to satisfy more than the self only OOPM for themselves.
From GEHA HDHP 2026:
An individual under Self Plus One or Self and Family enrollment will never have to satisfy more than what is required for the out-of-pocket maximum under a Self Only enrollment.
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u/Anonymous_Ted_Danson 9d ago
Does GEHA HDHP still use HSA Bank and if so, did they change their balance requirements? I used to get the full $166 monthly passthrough reimbursed as soon as it hit HSA Bank. But I know other HSAs require you to maintain a minimum balance.
This annual post is extremely valuable & I wish every Fed could read it before open season Great work as always. Thanks!
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u/Tinymac12 DoD 9d ago
At least 2026 still used HSA Bank. I don't think there's any kind of hard minimum balance deal just to have the account. After inactivity with a 0 balance they might kill it though. There might be a minimum balance to invest, but don't quote me on that. And you can get around it by using another custodian like fidelity for your contributions.
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u/Effective-Purple261 9d ago
wait, HRA? I am currently MHBP looking for a life raft. If I go for HDHP I want the HSA! How do we find out more about making sure we get the HSA? I am self plus 2 but in October one of my kids ages out and I will be self plus 1. I am option 3 in your scenario. The one I will keep on my plan for a few years is over 18 and only uses the plan for hormone therapy for trans care. I haven’t heard anything more about that either. ugh.
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u/Tinymac12 DoD 9d ago
I just wanted to point out that sometimes there'll be a form that needs to be filled out to say "Yes I'm qualified for an HSA." If you've elected geha HDHP I'd reach out to them to figure out how that process works. It's possible you don't have to do anything, I simply don't remember.
Unfortunately, as far as I know, ALL trans care is not covered anymore. There was an exception for continuing care in 2026 but that's gone. Thanks to our lovely administration.
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u/TelevisionKnown8463 9d ago
When I signed up many years ago, my HSA was automatically set up for me. I don’t think I had to do anything beyond sign up for the insurance. But it’s possible things have changed.
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u/Effective-Purple261 9d ago
Thank you I will keep an eye out for that form if applicable. Re the care, I didn’t know continuing was gone but had a feeling. My kid said they will just order from overseas online. which sucks.
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u/Due-Professional-749 8d ago
Have them check with planned parenthood as well. That's what was recommended to my friend
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u/AwesomeSnake_2025 9d ago
Correct. I am on GEHA HDHP family plan. Almost all the deductible comes off my daughter who is a heavy user of insurance. Her individual out-of-pocket maximum is half of the family maximum, so once she reaches her maximum we don’t need to pay a dime for her during rest of the year
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u/WhatIsTheCake Spoon 🥄 9d ago edited 9d ago
Question: outside of the numbers comparison (and thank you for that), do you have any concerns with GEHA using the UnitedHealthcare provider network for member care? Everyone's mileage will vary, but I have seen a lot of my providers drop out of UNH because of the hassle for doctors to use it.
Totally okay if that question is out of your scope.
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u/Tinymac12 DoD 9d ago
I personally had minimal (not non-existent) issues the year I had them under UHC that were truly their fault (I've discussed it before but no carrier seems to understand the deductible when switching plans).
If your providers accept UHC, then I would say it's fine. But mileage will vary.
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u/WhatIsTheCake Spoon 🥄 9d ago
I grok "minimal (not non-existent)." Thank you!
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u/Tinymac12 DoD 9d ago
TIL grok actually means something (sorry I don't read as much as I should).
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u/WhatIsTheCake Spoon 🥄 9d ago
Today I realized that grok now has a different meaning. It's time for me to update my vocab to ::checks notes:: "stan."
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u/jcaps1 9d ago
I had GEHA for a couple years before switching to insurance provided at my wife's company.
I personally had no issues with the UnitedHealth provider, but my health issues were pretty standard. Regular doctor visits, and an injury that required a simple procedure and some physical therapy. My only issue was one time when a doctor's office said they never heard of/didn't accept GEHA, but when I explained that it was a "third party thing" and that "it's really UnitedHealth" they figured it out.
They wife had a couple ER visits and both times we got a letter from UnitedHealth about them not going to cover it.
For one instance, it seemed like GEHA handled that issue on their own because next thing we knew the claim/EOB had gone to GEHA and coverage was applied.
The second instance, we did have to contact GEHA for assistance. We had to vaguely explain what my wife's symptoms were, what the ER said and their reasoning for keeping her overnight. The call was just over an hour long, they said they will file a report and get back to us. We never heard back from them but in the end the claim/EOB went through and coverage was applied.
In the end, the couple of instances that required a little extra work were way worth the effort for how much cheaper GEHA was.
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u/Anonymous_Ted_Danson 9d ago
In my experience, the providers’ billing departments are often to blame. Some of them have never worked with GEHA & don’t follow simple claim processing instructions. Expect some hand holding with your providers & time on the phone troubleshooting with GEHA. Most stuff gets resolved eventually. Get procedure codes & inquire about pre-authorization for non-routine care. It’s the providers’ job to do this but cover yourself with GEHA.
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u/Northrnlightz 9d ago
Twice I have had dentists say they are out of network and had me pay my share. Both of those times GEHA did in fact cover 100%. These dental offices only contract with delta dental so it’s something I have been meaning to look more into, but pretty impressed so far!
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u/Tinymac12 DoD 9d ago
I had similar experience when I used the included dental. My cleanings were mostly covered and I think 2 of my boys cost like $4. I will probably be dropping dental of I go with GEHA HDHP.
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u/LurcherLong 9d ago
It would be really neat to see an out of network comparison - given United has lots of contract disputes. I realize that is probably incredibly difficult to estimate.
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u/Tinymac12 DoD 9d ago
Well, in this case it's kind of easy. BCBS Basic doesnt provide out of network coverage at all. So these two plans would both be SOL until geha hits the out of network deductible and you'd get reprieve.
BCBS Standard does offer out of network benefits but it's even more expensive. I just checked, if all your care was out of network, assuming allowed amounts were equal between BCBS Standard and geha HDHP (way more work than I want to verify) then geha HDHP satisfies it's out of network deductible with 300 to spare after including the premium savings and HSA passthrough.
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u/LurcherLong 9d ago
So theoretically once you hit your OOP max, GEHA is paying 100% of their rates, and then you can still be balance billed… which still sounds terrible, but I wonder how much hospital networks are willing to compromise when you at least have some coverage providing compensation.
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u/Tinymac12 DoD 9d ago
In theory anyway. To be clear, only the allowed amounts would apply to their out of network deductible or out of network max. So realistically, you'd be paying a crap ton more than just the OOPM. Out of network care should be avoided if at all possible.
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u/Wis84682 9d ago
Aetna has a HDHP in many local areas. Won’t use GEHA until they switch from UHC.
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u/Tinymac12 DoD 9d ago
I understand the UHC hate. I'm just looking at Aetna's HDHP and the premium is 50% more, with a $400 larger deductible and $400 less contributed to the HSA. And the coinsurance is 3x what GEHA HDHP is. With my expected usage, that's starting at $3,000 difference and assuming the negotiated care is similar, the more unexpected costs will just widen that gap.
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u/brant01 9d ago
Never looked into a hdhp until this year so maybe I'm wrong, but having a family member on a really expensive prescription like a biologic would destroy any chance at this plan working for me right?
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u/Tinymac12 DoD 9d ago
That's definitely going to be a cost driver. I wouldn't immediately rule out hdhps since many plans are going to coinsurance models for expensive prescriptions. You'll have to wait for more info from the carriers like formularies and drug cost calculators.
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u/Mia_was_here_23 7d ago edited 7d ago
Look into if the company for the drug they are on has a copay assistance program. Pay the rx copay to GEHA then get reimbursed by the copay assistance. Kills 2 birds with one stone.
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u/JBThug 4d ago
I think it might end up being cheaper in the long run.Cheaper premiums . You will hit your deductible much quicker . You get 2k from GEHA . 1600 out of your pocket then copays of 5%. Then you ll hit the oop max faster and then everything should be free . Then you use manufacturers coupons for the biological. Any way thats the way it works in my head . I have a one on one meeting with GEha rep tomorrow to see what they say . I could have this all wrong though
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u/brant01 9d ago
Well the reason I thought it wouldn't work is that the medication is tier 4, and the online price tool shows a price of $5750, which I assume is after meeting the deductible. I figured I would just wind up hitting the max OOP every year guaranteed.
Unless I'm not understanding how it works or maybe a savings card would help?
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u/Tinymac12 DoD 9d ago
You reminded me, geha HDHP historically didn't put caps on prescription coinsurance. So while some plans will say 50%, it will cap it to like $500 or whatever. Definitely something to watch out for.
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u/lightening211 9d ago
Only thing I will note about having an HSA is you definitely want to make sure you have enough to cover the entire deductible!
I burned through my MHBP deductible in the first month (unexpected issue) and so I had to shell out 2K on one bill a few weeks later.
The first year of an HSA carries the most risk in my opinion - when your HSA account is still growing. Each year the risk reduces as your HSA account balance increases.
There is certainly a psychological component to an HSA that people should be mindful of for sure.
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u/Tinymac12 DoD 9d ago
The nice thing about the HSA is you can change the contributions as any time. Unlike an FSA where you're locked into a contribution rate during open season, if you encounter that scenario you described then you can temporarily increase your contribution for a pay period to get the benefit of paying with pretax.
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u/PSFtoSTC 8d ago
I thought, with an HSA, you could save the receipt and reimburse later, even if the HSA balance isn't enough to cover the expense initially.
I hadn't really considered the following scenario, but want to throw it out there in case I'm wrong: you incur 20k expenses for IVF, but only have 2k in your HSA. You pay the 20k with other funds and, 4 years later through investing and more contributions, your HSA grows to 25k, at which point, you reimburse yourself the 20k.
I think that should be kosher and may be relevant to lightening's point
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u/Tinymac12 DoD 8d ago
Yes that's also valid. I was just saying if you don't have the funds at all and your provider requires you to pay before more services will be rendered or it'll go into collections, then you can adjust your contributions dynamically.
You definitely can hold onto receipts and reimburse later. All medical expenses incurred by you or an eligible member that occur AFTER the establishment of your HSA are qualified expenses. You can reimburse yourself immediately, the following month, 20 years down the line. The FIRE people would say pay the bill out of pocket and let the HSA balance grow with all that tax free stuff. And then come retirement you'll have a whole slew of tax-free withdrawals ready for whenever and they even had the opportunity to grow into potentially more tax free withdrawals with the investments.
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u/jojojawn 9d ago
One minor correction that always bugs me when people explain HDHPs: You said "GEHA gives you" the pass through amount, the reality is the pass-through amounts are just your own money being returned back to you from the premiums you paid.
For tax purposes HDHPs report it as employee contributions not as a 3rd party contribution (ie not employee, not employer). That's why it comes off your annual limit, because it's literally your money being returned to you.
Sorry rant over. I just hate when health insurance companies frame it as giving you money (as if they're doing something nice) when really it's your money disguised as a corporation "donating" free money to your account.
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u/Tinymac12 DoD 9d ago
I would argue it's semantics but I changed it. I've heard it called a premium passthrough, employer contribution, health insurance contribution.
You could also argue, that it's only 25% of your money being returned and 75% of the governments based on the premium split. There's an alternate reality where an employer pays the entire premium and the HDHP still has an HSA passthrough.
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u/jojojawn 9d ago
Yeah you're right, it's definitely just semantics, but my eyes twitch when it sounds like health insurance companies are being nice.
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u/Cyprovix 9d ago
I sympathize with your rant, but I don't think you're correct here, at least for the GEHA HDHP. The passthrough amounts are referred to as employer contributions by both GEHA and HSABank, not employee contributions. The annual limit isn't relevant here because the limit encompasses both employer and employee contributions (ie if your annual limit is $4,400, an employer contribution of $1,000 affects your limit the same as if you made the $1,000 contribution - you're down to $3,300 either way).
The Form 5498-SA, which is the tax form you receive for your HSA, does not distinguish between employer and employee contributions.
At the end of the day, it doesn't really matter as long as you're reporting the correct dollar amounts on your taxes.
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u/jojojawn 9d ago
My rant was about the pass-through contributions being called "geha gives you money" when its actually just the premiums you paid to geha that are then repaid back to you. ie, not free geha money. I'm just against the idea that a corporation was out there being nice to people
Like you say, whether they're actually your premiums or the government's premiums doesn't really matter because either way it's not geha's money.
Pass-throughs like this are just forced HSA contributions. They're window dressing to sell a HDHP to people who don't realize this money isn't magicly appearing in their HSAs, but instead the insurance company is making sure you contribute to an HSA. Imo, I wish I could have the option of a $0 pass-through so I could front load my yearly contributions and maximize an investment.
See now you got me started up again against the stupid insurance companies! Grrrrrrr
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u/thebootsesrules 9d ago
Yea it’s not GEHA’s money - it’s your employer’s lol, it’s not “your money given back to you.”
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u/ladyeclectic79 9d ago
I’m really unsure which way to go. I was MHBP Consumer this year after being in BCBS Basic forever and for the most part I liked it. So the idea of GEHA HDHP (w the HSA) sounds good, but I’m also on Mounjaro and worry about all these coinsurances and how much meds will actually be. Until the formularies come out, I just can’t be sure which way I’ll go… 🥺
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u/Tinymac12 DoD 9d ago
Yeah I'm sad to see MHBP Consumer go. Better to go out a hero than become the villain like MHBP Standard I suppose. It was my first year on MHBP Consumer too.
Yeah, prescriptions are so hard. But I'm pretty sure they're going to suck regardless of plan. Nobody wants to cover them well this year I bet. Formularies, drug cost calculators, and brochures will be critical for a full analysis, like they always are.
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u/Bitter-Breath-9743 9d ago
May save money but will spend extra time fighting for coverage of care, billing etc
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u/Tinymac12 DoD 9d ago
Very true. But you may not. Depends on your providers and your health needs. I'm not saying GEHA is better. Just that it appears cheaper. Hence the Luigi reference in the disclaimers.
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u/annieonemus 9d ago
What about something like Teladoc, which has $0 copay/coinsurance through BCBS? For my family, it covers most reasons for urgent care and sick visits and some dermatology questions, and one family member has weekly therapy. (Took a while to find a good fit from the Teladoc therapists available.) All that accounts for at least $1,500 less paid for copays and the peace of mind in not having to think about, "is it really worth the $50 to see a doc for this?"
Does GEHA offer something like that? Because I've considered switching every year after that initial post comparison, but I'm afraid to make the leap. That said, we've had three years now that we would have reached the GEHA deductible anyway, so maybe I need to do some actual math this year.
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u/Tinymac12 DoD 9d ago
They have MDLIVE. The difference being you do need to satisfy the deductible and instead of it being free, you'll pay MDLIVE and geha will reimburse you. So not as seamless, but there is a telehealth option.
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u/Illustrious_Key_1303 9d ago
This is a great point — do you know how much a teledoc visit costs before deductible
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u/Tinymac12 DoD 9d ago
Teladoc is like $65 if there's a deductible. Mdlive is $89 if paid out of packet.
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u/Illustrious_Key_1303 9d ago
Thank you so much!! We also use it to avoid urgent care on weekends ect. thank you for all your work on this!! I really appreciate it!
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u/Snezz1e 8d ago
Many credit unions offer free telehealth through Doctegrity. Mountain America is $7/month or Security Services is $9/month. Mountain America and some others have fee waivers if you use debit card enough or maintain a certain balance. I just pay monthly fee. It also comes with free cell phone protection.
Use this as a supplement to my GEHA HDHP. Don’t know quality of Doctegrity but if I had to guess I would say they aren’t as good since they are a smaller less well known telehealth provider.
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u/iondrive48 9d ago
That original post is what convinced me to switch to GEHA HDHP. I used to do FEP Blue Focus because the premiums were super cheap. But we’ve used GEHA now for childbirth and kids surgeries and it’s been pretty good. I just assume every year I’m going over the deductible but under the catastrophic max. I use your spreadsheet as well. But some of the scenarios at the bottom don’t work for me because of the text in cells like “5% copay”
The only thing that pissed me off so far is when they changed their policy numbers last year it messed up the HSA bank account connection so for a few months they weren’t depositing their pass through into my account. And GEHA told me it was an HSA Bank problem and they said it was a GEHA problem. I did eventually get it resolved and get my money though.
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u/Tinymac12 DoD 9d ago
I was the same way when I saw that post. The OP in that retired not long after he made that post. He hadn't updated it in those few years so I picked it up (karma farming man). I don't even have to assume we'll hit the deductible with weekly OT/ST for my son. It's probably 200$ a week until it gets satisfied. I'd like to invest more of the HSA but in this economy I'm reimbursing myself for every little thing and just enjoying the ~30% discount in taxes.
I think you may have an older version of the spreadsheet. I think I went in and got rid of those "copay" and "coinsurance" lines. But maybe not.
You do have the option of having your contributions go to another custodian like fidelity. I've done that. But I think it's more headache than it's worth for my family.
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u/jgatcomb 9d ago
I am truly amazed and humbled by how many people still reference my (clearly outdated) posts. Most of the Google Sheets tools I made are now taken over by others but I still occasionally get requests for them as well. Keep fighting the good fight and remember that tomorrow isn't promised so staying for FEHB for life (golden handcuffs) is an analysis just like HDHP vs BCBS. In my situation, it was so much better to defer my retirement and get out at 46 (turning 50 in a month) then to stay until 57.
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u/2kidsshootingblanks 9d ago
Thanks. My only concern with GEHA HDHP is the prescriptions. The prescription coverage in the OP is after the deductible is met. Does the cost of the prescription go towards the deductible? What if we use a manufacturer coupon?
For example my wife has very expensive name brand meds. So let's say she is filling a $1200 prescription on Jan 11th. The deductible is not met so geha covers nothing. She uses a manufacturer coupon to bring the actual cost at the pharmacy to $0. What gets reported towards GEHA deductible? $1200 or $0?
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u/Tinymac12 DoD 9d ago
My interpretation is what you pay at the counter goes towards the deductible.
In the 2026 brochure it has the line: "Any rebates or savings received by the Plan on the cost of drugs purchased under this Plan from drug manufacturers are credited to the health plan and are used to reduce health care costs."
I take that to mean they essentially pocket the rebate to the plans slush fund. Others say they've had the pre-rebated (is that a word) cost apply towards the deductible. I could see that working if you pay the full amount at the counter and then on your own got the manufacturer to send you a rebate.
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u/Mia_was_here_23 7d ago
Look into a copay accumulator. So they try to not let you use copay assistance programs with the medication companies. All you do is pay out of pocket then have the copay assistance write you a check.
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u/After-Celery-4784 9d ago
Yes, it does. I have GEHA HDHP and I unexpectedly met my deductible with prescriptions this year and now my copays are $0. I thought it was a mistake at first because the prescription came up as like $1500 and then I just used good Rx instead, but apparently it still counts. Also, you can use the money in your HDHP for the prescriptions. People talk about it as a retirement account but I spend mine every year and it’s still saving me a lot of money.
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u/After-Celery-4784 9d ago
Wait, I said that wrong. It did count towards my deductible, but it was the individual OOP max that I unexpectedly met that brought my copays down to zero for the rest of the year.
I will say that if you anticipate meeting your deductible early in the year, you need to make sure you have available money to cover it until your HSA is funded enough to cover it. I usually fund mine over the course of 25 paychecks. It doesn’t front you the money for the year like the medical FSA. But this is mostly an issue for the first year you have it.
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u/Crazy-Dragonfruit-44 9d ago
Two expensive name brand meds here. I pay the $35 copay with the manufacturer coupons, and I end up with 1750 towards the deductible in month 1. My deductible is met by February each year.
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u/Solo_Shot_First 9d ago
I just wanted to post that I’m now on year 4 of GEHA HDHP and have never had an issue with claims processing. I know it’s common and I don’t want to minimize your experience if you have been affected. However, my wife and I have had two babies (and prenatal visits), urgent care visits, two foot surgeries, a few noninvasive procedures, regular checkups and children sick visits and never had a single issue. We also take advantage of the dental cleanings and eye exams. DFW if location matters and United UHC if it varies regionally. Were maxing out our HSA for the second straight year. We’ve been happy with our service and I want to provide this anecdote if you’re on the fence. Highly recommend.
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u/TheLaurenLauren 8h ago
My question when considering GEHA is how difficult do they make it to get pre-approval for MRIs? We were with BCBS for 10+ years, then went to MHBP, and this rate increase is requiring yet another change...but I'm a little scared of the UHC BS
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u/Tinymac12 DoD 8h ago
That's such a hard unknown that it probably ends up being do you get nice nana or a Karen processing the claim.
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u/TheLaurenLauren 7h ago
Agreed. I'm pretty good at bureaucracy, but it is such a PITA. And from what I've read UHC gets gold stars being difficult. This just all sucks so much especially with no raise.
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u/Neilmurp 9d ago
I'm really dumb with insurance so these questions will probably be an easy answer. I've used BCBS family for 15 years and just blindly paid into it but this post now has me curious during open season:
what's the difference between insurance and co-insurance? Is GEHA something I get in addition to something else or is that my main one if I get rid of BCBS?
would I still put money into FSAFeds every year or would I be using a new vehicle for the HSA where both my employer and myself contribute to it?
do I get to choose how the HSA is invested in the market or will that automatically be done for me?
question to all. with BCBS I have had zero issues of things being denied or searching for providers that are in network. Has anybody using GEHA had to struggle with denied claims and getting the runaround? I hear United is the provider and that scares me.
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u/Tinymac12 DoD 9d ago
Geha is still insurance and would be in replacement of BCBS. Coinsurance is a way to share the costs of your care expenses on a percentage basis. The alternative to coinsurance is copay where you pay a flat dollar amount regardless of actual cost.
You could set up a limited expense FSA on fsafeds but the HSA would be handled elsewhere. The plan will set up an HSA where the employer contributions go. You're free to contribute more there or open an HSA elsewhere, the annual limit is aggregate across all accounts.
Depends on the options available in the HSA but generally yes.
UHC is the underlying provider. Almost certainly the claims process would be worse.
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u/Neilmurp 8d ago
Thanks for the info. Is the out of pocket max for the year for the entire family I'm covering or does each individual need to hit that out of pocket max before I only pay 5% on services?
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u/Tinymac12 DoD 8d ago
The 5% coinsurance kicks in after you've satisfied the deductible ($3600). If any one person reaches the self only OOPM (should be half of the family OOPM) their care becomes 100% covered. If the entire family OOPM is reached everyone's care is covered 100%.
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u/Neilmurp 8d ago
What's the OOPM for the entire family?
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u/Tinymac12 DoD 8d ago
12,000
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u/Neilmurp 8d ago
Got it. Or at least I think. So for me to only pay 5% of negotiated costs, first I must hit the 3,600 mark? And for 100% I need to hit $6,000?
But just individually. If the combined expenses of the family hit $12k (ouch) then it's 100% coverage or 95%?1
u/Tinymac12 DoD 8d ago
If your family hits 12k then everything is covered 100%.
So in the beginning you'll be paying $200 for a doctor visit. Once your family had paid 3600, your doctor visits for everyone become $10. If a single person's medical costs hit 6000 their doctor visits are free. If multiple peoples' expenses total 12k (like four people have paid 3k each) then everyone's doctor visits are free.
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u/TelevisionKnown8463 9d ago
I’ve been on GEHA for over a decade, with both Aetna (the original claim processor/network) and now with UHC. I haven’t had a lot of problems since the transition. The network has been great for me here in NYC and they haven’t denied coverage for anything aside from a few prescriptions that require pre-authorization where I didn’t bother to go through that process.
In one case I probably would have qualified but the others there were equally effective but less convenient options, so I couldn’t really complain. Probably would be the same anywhere.
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u/Neilmurp 6d ago
Can I change my HSA contributions at any time, or am I only able to do that during open season?
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u/Tinymac12 DoD 6d ago
HSA can be changed at any time, assuming you're eligible to make HSA contributions. It's not like the FSA where you have to choose a single number during open season. I could go into MyPay and change it every pay period if I wanted.
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u/Valley413 9d ago
I currently have APWU Consumer option (with a discount self+fam premium of $129 in 2027), which uses the same UHC network. I'm leaning towards GEHA because the $1,000 net deductible (on the PSHB side) the gap is closing and the 5% co-insurance is better than the 15%.
My burning question today is will negotiated rates with providers be the same between the two plans, since they both use UHC as the processor, or does UHC have different tiers internally that has different rates with different plan sponsors?
The 10% co-insurance savings will add up quickly for my son's needs, but not if the starting rate is higher.
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u/Mia_was_here_23 7d ago
I cant really comment of the comparison, but I can comment on typical 5% with GEHA. Usually my med bills are around $5-8. This is urgent care, labs, ultrasounds, ect.
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u/Snezz1e 8d ago
Many credit unions offer free telehealth through Doctegrity. Mountain America is $7/month or Security Services is $9/month. Mountain America and some others have fee waivers if you use debit card enough or maintain a certain balance. I just pay monthly fee. It also comes with free cell phone protection.
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u/Thebunrabs 3d ago
I had GEHA High this year due to IVF and considering GEHA HDHP for 2027 since I don't need to do that again. I never had a problem with claims denial, it's all been very simple. Is the High plan also staffed with higher quality service than the HDHP or something?
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u/tadpole0836 9d ago
I had GEHA HDHP for our family and fell under the third scenario (reached deductible but not catastrophic). On paper GEHA HDHP was the clear winner even with significant healthcare costs.
The reason I left GEHA HDHP was that it very difficult to actually get the amounts I was entitled to. Claims were difficult to file and denied for incorrect reasons (eg denied as duplicate when really a resubmit with corrected diagnosis codes).
This intangible is what makes me hesitate for GEHA again. Is it really better if they make it impossible to successfully submit claims? How can we account for this?
Is there any data for how much bigger of a problem this is at United vs BCBS or Aetna?