TOPICS
TOPICS
Health Plan Checkup
The annual open season for federal benefits elections started on Monday, and given the recent spike in premiums and the introduction of new coverage options, it may be wise to weigh alternatives to your current plan.
During an online seminar hosted by Government Executive, Walton Francis, author of Consumer's Checkbook Guide to Health Plans for Federal Employees and Annuitants, encouraged employees to do their homework prior to selecting a plan.
Most employees have 20 or more options and can switch plans regardless of pre-existing conditions, Francis said. When determining which offering is the best fit, he recommends considering a variety of factors: your family size, age, pay system, full- or part-time status, geographic area, retirement status, Medicare status and overall risk of high medical costs.
Researching health plans "is a prudent and smart thing to do," Francis said. "Take into account whether or not you plan to have a child next year. Most conditions you can't foresee, so ... you should try to prepare yourself against the worst."
Premiums will rise an average of 7 percent in 2009 according to the Office of Personnel Management -- the largest increase since 2005. But much of that increase was fueled by higher rates for Blue Cross Blue Shield Standard, the most popular FEHBP option. About 60 percent of program participants have selected that plan.
Also bear in mind that the actual increase will vary depending on the category of health plan you choose. It will make a difference whether you pick a traditional fee-for-service plan, a health maintenance organization, or a consumer-driven or high-deductible plan. For a self-only General Schedule employee in the Washington area, Francis said, annual premiums will range from $560 to $2,550. And while all plans provide reasonable to good coverage for catastrophic medical costs, he said, the best plan has a limit almost $10,000 higher than the worst.
Francis strongly encouraged employees to look at high-deductible and consumer-driven plans, noting they offer "some of the best bargains in the system." These plans provide you with a savings account larger than your actual premiums after taxes. You can end the year with more money than you started if your medical costs are low, and you're protected if your costs are high, he said. In low-cost years, and most but not all high-cost ones, you can save $500 to $1,000 in high-deductible self-only plans, and even more in family plans, according to Francis.
"These plans are not too difficult to understand," he said. "They have features that are desirable, and they have almost no undesirable features except for the one they're famous for -- that high deductible."
Employees also should consider HMOs, Francis said, noting that the M.D. Individual Practice Association health plan is a good alternative to Blue Cross Standard. Employees might want to look at less expensive national plans as well, including Blue Cross Basic and GEHA Standard, which are "much better buys than Blue Cross Standard," he said.
In addition, Francis encouraged employees to enroll in flexible spending accounts, which allow participants to put aside money, tax-free, for health costs ranging from dental care to sunscreen. "Amazingly, only about one in 10 employees enroll in an FSA," he said. "It's probably only worth a few hundred bucks to you, but if you don't get that few hundred bucks, you're throwing it away."
It also could be beneficial for agency leaders to learn more about the savings that can result from employees enrolling in lower-cost plans, Francis said. The government pays about 70 percent of the premium for most plans, but agencies can save an average of about $2,000 for every employee who switches to a lower-cost plan, he said.
Francis advised employees to read the brochures for all the plans they're considering for 2009. Their research should focus on the How We Change and the Summary of Benefits sections, he said. Also, some plans exclude deductibles and co-payments for catastrophic limits, which can distort the actual cost by thousands of dollars, according to Checkbook's guide, so be wary of misleading figures in plan summaries.
Many federal agencies have contracted with Consumer's Checkbook to provide free online access to the health plan guide for their employees during the open season period. Click here to see if your agency is among them.
FEHBP participants also can use OPM's online plan comparison tool to look at the benefits and costs of as many as four different plans simultaneously. OPM updated the tool with 2009 data on Nov. 3.
You have until Dec. 8 -- the end of open season -- to finish your homework.
COMMENTS
- @ICEd - That's correct. BCBS makes you pay 100% of the first $7,500 in non-participating surgeon's fees and 100% of the first $800 of non-participating anesthesiologist's fees. This is a huge gotcha that has not received much attention. I'm changing out of BCBS for 2009. Geoff Posted December 1, 2008 3:52 PM
- A friend who was looking at the new 2009 BCBS Benefits Plan Brochure called and warned me that for 2009, BCBS will not cover the first $ 7,500 of the surgeon's fee if you get surgery by a non-participating surgeon, even at a hospital that is BCBS participating. I haven't received the 2009 Plan Brochure yet, but can anyone confirm that? When I get the Brochure, I'll be sure to read it carefully, and compare it line by line with the current one. Apparently, BCBS isn't satisfied with a 13.4% premium increase for federal employees, and a 33% increase in the co-payment amount, not to mention the increases for prescription drugs. I would advise everyone on BCBS to check the 2009 Plan carefully for changes like this in our coverage, and make your displeasure know to your Human Resources office, OMB, and your elected representatives! ICEd Posted November 24, 2008 3:21 PM
- I agree, premiums are going up and benefits are going down--especially with BCBS, Not only that, but beware, BCBS will drop a provider without notice to you or the provider and then to top it off, back date the termination, then leave YOU to pay for the full office visit. Pay attention to the benefits---it is a great thing to elect their standard option thinking you get out of network benefits if you need them. But now beware! They will not pay the first $800 for an out of network anesthesiologist and will make you pay the first $7500 for an out of network surgeon. You may think it is no big deal--just use in network, but there many employees in rural areas that have no choice. So, higher premiums, lower benefits, and a shrinking provider pool.---Way to go OPM, you guys really know how to negotiate and watch for us--the employees. Lewis Posted November 19, 2008 6:51 AM
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