Every year there are changes to the benefits of almost all Federal Employee Health Benefits plans. All too often these changes cost enrollees money through increases in their deductibles, their physician copays, or their prescription drug copays.
Adding insult to injury, plan premiums always go up on average, and of course that means that premiums go up by more than average in about half the plans. For next year, the all-plan average premium cost to enrollees will go up about 6%. That translates into an average dollar cost of about $140 a year for self-only enrollments, about $270 a year for self plus one enrollments, and about $330 a year for family enrollments. Some plans went up a lot more, such as the $975 dollar a year increase for the family premium in the APWU High option plan. Of course, some plan premiums went down–the MBHP Standard option premium went down by $530 a year for self plus one enrollees.
How bad were the benefit reductions? And were they offset by benefit increases? These are tricky questions because what is important to one family may not be important to another.
For example, only a fairly small fraction of enrollees will start to use hearing aid benefits next year. For that fraction, it may well be important that GEHA Standard option now will pay up to $2,000 per ear for both children and adults, compared to $1,000 in 2016, a benefit improvement. But some other plans pay up to $2,500 or $3,000, so GEHA remains a bit below those, though higher than the many plans that provide no hearing aid benefit, or one limited to either adults or children.
There is another issue: the number of changes is massive. Benefit changes for next year are shown in each plan’s brochure, in “Section 2. Changes for 2017.” On average, national plans show around two dozen “changes” and one dozen “clarifications” in each brochure, but the numbers vary widely.
Many changes apply to one option or another, but many apply to both. In almost any given geographic area about 25 plans are available. Assuming 10 substantive changes, the typical enrollee faces a barrage of perhaps 250 benefit changes, any one of which might be important.
Alas, no compendium of these exists. The only way to find out what is changing in your plan is to download the brochure, turn to Section 2, and try to determine what is changing.
But now another problem arises. Sometimes the plan describes the benefit change comparatively, e.g., “the hearing aid benefit under standard option is now $2,000 per ear, compared to $1,000 last year.” Just as commonly, the comparison is not explicit, and the only way to know if the change is good or bad, or substantial either way, is to look at the brochure for the prior year. This quickly gets tedious!
There is one summary source of information on 2017 changes. The National Active and Retired Federal Employees Association (NARFE) has compiled a list of plan benefit changes in its December, 2016 magazine issue. NARFE members can check it out.
But the list has limitations. It only covers national plans open to all—no local HMOs or restricted enrollment plans, and no national plan that is not so labeled, like Aetna Direct. It only covers the benefit changes selected by NARFE staff as especially worthy of mention.
NARFE did a good job at this, but the old saying “one man’s meat is another man’s poison” comes into play. The benefit change NARFE chose to present may not be the change that really matters to you and your family. Moreover, several important categories of change don’t appear in Section 2 and were not listed by NARFE, including changes in plan coordination with Medicare. Hence, the NARFE listing cannot and does not highlight every change that may be important to you.
My overall view, after having personally studied Section 2 of every single plan brochure, is that the vast majority of changes for 2017 are not of great magnitude, and are beneficial to enrollees. In CHECKBOOK’s ratings of all plans, there were only a handful where the overall value of plan benefits decreased.
The biggest overall change in the program is the growth in the number of plans offering Medicare wraparound benefits. The number of plans offering “free” hospital and physician care to enrollees with Parts A and B of Medicare grew substantially. Most of this growth was in local plans, and for many enrolled in those plans this will be important.
Finding your health plan’s changes
What is the best way to find out if your plan reduced (or increased) its benefits in ways important to you and your family?
Step one is quite simple: download your plan’s brochure, read Section 2, and then double check on benefits of special importance to you.
For example, if you plan to have a baby next year, search the brochure on the word “maternity” and review that benefit carefully.
But this step omits the most important issue: finding the plan with the best overall benefits as well as good maternity (or whatever) benefits. It makes no sense to choose a plan that will save you a few hundred dollars in chiropractic benefits if its premium is thousands of dollars higher than other plans.
Step two requires a bit more work: use either the OPM or CHECKBOOK web site to compare three or four plans that seem to you to be overall good buys.
CHECKBOOK’s Guide includes the important feature of estimating likely overall costs to families like yours, including both premium and out of pocket costs, to get you to this point. You can then check less costly plans side-by-side on a few dozen benefits. But neither comparison tool can cover in detail hundreds of detailed benefits or plan characteristics. So you can’t avoid digging deep into one or more brochures, or talking to medical specialists about “which plans pay better,” if you have special needs.
If you work for one of those agencies that doesn’t make CHECKBOOK’s Guide available free to its employees, here are most of our overall better buys for the DC area and in most cases nationally, for most families in most circumstances, taking into account both premiums and the most important (to most) 2017 benefits, with or without Medicare: both Kaiser options and Aetna Open Access Basic HMOs; NALC, APWU, and Aetna Direct Consumer-Driven plans; GEHA, Aetna, and CareFirst HDHP plans; and GEHA Standard, Blue Cross Basic, and NALC High among traditional national plans. Among these dozen plans you will find excellent overall benefits and relatively low costs with potential savings in the thousands of dollars a year, and are very likely to find a good match for any specialized medical needs of you and your family.
Walton Francis is the principal author of CHECKBOOK’s Guide to Health Plans for Federal Employees, available online at www.guidetohealthplans.org, including all text for free and a detailed listing of federal agencies that provide free access of plan ratings to their employees.