Expert's View

It’s Open Season again, a time when federal employees and retirees who are enrolled in the FEHB can change their coverage and for those who aren’t enrolled to do so. This year Open Season will run through December 13, so don’t miss your opportunity to reassess where you are and consider where you want to be when it comes to health benefits.

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While part of your assessment will be based on the premiums you’ll have to pay, equal weight should be given to what you anticipate your health needs to be in the coming year. Simply stated, you’ll have to do a cost-benefit analysis.

Among the positive changes in the FEHB program that you don’t need to consider are these. For 2011, every plan will provide preventive care and screening with no out-of-pocket cost to you. In addition, if you have any children under age 26, you can add them to your self-and-family coverage. Finally, if you need help to stop smoking, your plan won’t charge you any co-payments for seven FDA-approved medications, two tries to quit each year, and four counseling session each time.

Among those that you’ll have to consider are the premiums charged by each plan. On average they’ll be going up 7.2 percent, which translates, on average, to a biweekly increase of $5.53 more per pay period for self-only coverage and $11.45 for self-and-family. Retiree premiums are paid on a monthly basis rather than biweekly, remember.

While these average increases are substantial, they aren’t the same for every plan. Your plan (or the one you are considering) may have higher or lower premiums. That brings us to the next point to consider: benefits. While plans generally cover the same things, they cover them to different degrees and with variations in the amount they pay versus what you pay. As a result, you’ll first have to consider the benefits you know you (and your family) will need in the coming year. Then you’ll need to consider what may be lurking in the background, based on conditions you and your doctor have been monitoring, hopes for a pregnancy, a family history of illness or disease and so on.

If you are eligible for Medicare, you may also want to consider something new being offered by two fee-for-service plans. GEHA and Mail Handlers are offering a pilot program that will more fully coordinate their benefits with Medicare. Here’s the way it will work. If you accept the same copayments and or coinsurance as non-Medicare enrollees (FEHB plans commonly waive those for their enrollees who also are enrolled in Medicare), they will contribute toward the cost of Medicare Part B premiums. Again, depending on your past patterns of medical care use and your projections of future use, this may or may not make sense for you.

Whatever your situation, to help make a decision, you can go to OPM’s website at www.opm.gov/insure and download the Guide to Federal Benefits as well as copies of the brochures of plans for which you are eligible. With these in hand, you’ll be on your way to making a wise decision for 2011.