Spend That Half-Hour Evaluating Your Health Plan

by Lesley Politi on December 2, 2008


Tuesday, November 25, 2008; Page D04


One of the good things about being a federal employee is the benefits package. The choice of health insurance plans, for example, is enough to make a private-sector worker jealous.

If there’s a downside to that variety, it’s that the choices are so great that Frank and Flo Fed can be confused by all the possibilities.

That’s where Checkbook’s 2009 Guide to Health Plans for Federal Employees comes in handy. Published by the nonprofit Center for the Study of Services, which also publishes Washington Consumers’ Checkbook magazine, the guide provides real cost comparisons of health plans and much more information.

During a busy health insurance fair at the National Institutes of Health yesterday, the Federal Diary spoke with Walton Francis, chief author of the guide, for tips on how federal workers should approach open season, which ends Dec. 8. That’s the period when they can make health-insurance changes. Here are edited excerpts of his comments:

His Most Important Suggestion

Spend a half-hour thinking about your family’s health situation and the plan you are in and see if there is something about your circumstance or the plan that has changed. It may be time to think about changing plans. The whole point of open season is to reconsider your choices. So spend that half-hour. . . . Just think about your circumstances and glance at the plan you’re in.

Premium Increases

Blue Cross standard option has about half the enrollment of the federal workforce. Its premium went up 13 percent, so that drove the average for all federal plans up 7 1/2 percent right there. The other plans basically are flat. Blue Cross standard was already on the pricey side, before the change. . . . So the practical thing for roughly half of all federal employees and retirees this year . . . who are in Blue Cross standard option is to think about their choices.

They don’t have to be radical about it. They can move to Blue Cross basic, which is a very good plan — one we rate quite high — and save a ton of money on premiums.

Shortcomings in Plans

There are always shortcomings in the sense that . . . there’s some particular benefit you want [and it might not be available]. . . . For example, if you want acupuncture, about half the plans cover that and about half don’t. If you want [to see a] chiropractor, also about half the plans don’t [cover it] — and not the same half. Some cover skilled nursing care after a hospital stay, some don’t. . . .

Differences Among Plans

It’s both what they cover, which tends to be very broad, but not absolutely uniform, and the co-pays and deductibles and how they play out. And then there’s the question, for example, of what plan is your physician in? To some people, that matters a whole lot. Others couldn’t care less. . . . So there’s a lot of factors to take into account.


There’s the standard complaint, every year: “Oh, it’s so confusing, there are so many plans.” That’s always complaint No. 1. Complaint No. 2 is premium increases, particularly when there is a big one. . . . And a third category would be some benefit change that someone is using. . . . They [insurance companies] tend to add more than they subtract.

A New Benefit

Here’s one most people don’t even know: If they are couch potatoes and don’t spend a half-hour glancing at their plan brochure, they won’t know that most of the plans now cover hearing aids for adults. That’s a huge benefit change for people who need them. That’s something to pay attention to, and [the plans are] not all equal. Some hearing aid benefits are better than others.

Consumer-Driven Plans

There are a lot of really good buys in consumer-driven plans [which are] high-deductible plans. There’s about seven or eight of them in this area. . . . The basic idea is that the plan gives you some kind of savings account. For a family, it could be . . . $1,000 to $1,500. You get free preventive care, free vaccines, immunizations for your kids. . . . If you keep your health-care usage below that savings account level, then at the end of the year you carry the funds over and have them available for next year. . . . If health-care expenses are really low, you could actually wind up the year with more in your savings account net than you spent on the premium.

However, once you blow through the savings account, you pay the next, typically $1,000 to $1,200 for yourself and a couple thousand for a family. In that case you pay it all, 100 percent out of pocket. So it really pays to think hard before you hit that hole. Once you blow past that, then the plan covers you 95 to 100 percent, just like all the other plans do. And they all have excellent catastrophic protection, loophole free. The most you can be out of pocket no matter what happens to you [is $5,000 to $10,000].

Adult Child Coverage

The new option this year that’s very interesting to many is the Samba plan. . . . If you’re in the plan . . ., you can buy a policy for your child, turning age 22, up through age 27, for about $200 a month, no questions asked. . . . Preexisting conditions — not an issue. That’s a very interesting choice and one that some people certainly would want to use.

Source: www.washingtonpost.com

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