Open Season for federal employees’ health benefits always generates a lot of press on the plans and premiums.
In a recent article in the Washington Times, Mike Causey noted that even with the mountains of paper generated by the insurance companies each year to promote their plan, only about 6% of federal employees change health plans each year.
Does that mean that 94% of federal employees are in the health plan that best fits their needs? Probably not. It probably has something to do with the mountains of paper mentioned above.
There are some tools available at websites like www.checkbook.com, www.plansmartchoice.com, or www.opm.gov, but they still leave gaps. So what questions do you need to ask to choose the best health plan for you and your family?
The inclination might be to start by looking at premiums, but how your health care is delivered (i.e., the type of health plan you’re in) is just as important. Choosing the type of health plan is about both the level of control you have and cost.
Do you want a health maintenance organization (HMO), a regional preferred provider plan (PPO) or a fee for service plan (FFS).
HMO’s are for those who want a self-contained health plan. You’ll choose a primary care physician from an approved list, and they will be responsible for directing the traffic on your health care. If you want to see a specialist, your primary care physician has to refer you. Tests, surgeries and therapy all have to be recommended by the primary care physician. In exchange for you having less control, you pay lower premiums, and typically there’s not a deductible but you do pay co-pays.
PPO’s – those plans that vary by state and regions within states offer the option to choose your doctor or specialists from a list of preferred providers that the health plan has negotiated contracts with. These are known as "in-network" providers. You have greater control over your health care providers with higher premiums than an HMO. There are usually deductibles and co-pays associated with these regional plans.
The FFS plans are available to all federal employees or retirees throughout the country. The most common FFS plans are:
- Blue Cross Blue Shield
- Mail Handlers
There are several additional plans that are available only to specific groups such as Panama Canal workers. FFS plans look much the same as the regional FFS in that you can choose your own doctor and specialists from a list of in-network providers. After your deductibles are met, the insurance usually covers 80% of reasonable and customary expenses up to your annual out-of-pocket limit.
When you look at the annual out-of-pocket limit in the plan documents, you need to ask what counts in that limit. It varies from plan to plan, and even if the annual limit is lower, if your deductible and copays for formulary don’t count toward that out-of-pocket limit – you might end up paying more in overall healthcare expenses.
Choosing the type of health plan is only the first step in narrowing down your Open Season choices. Watch next week’s column on trimming your best choices even further by selecting from traditional, consumer-driven and high-deductible health plans within the HMO, PPO and FFS plans.