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Following is a section of OPM’s new report on findings of the 2023 Federal Employee Benefits Survey addressing reasons for why people choose, and consider changing, health insurance plans.
To better assess how many employees may be evaluating FEHB plans each year during Open Season, respondents enrolled in FEHB were asked if they had considered changing their plan within the past 5 years.
Over one-third of respondents (40%) reported they had considered changing their plan. To understand how employees make decisions related to health plan choice, those who had considered changing their plan were asked to identify the reasons why they consider changing plans.
The results suggest cost is a major driver of considering a health plan change, with the top reasons all relating to wanting lower payments or premiums. The results are displayed in the table below.
Reason for Considering Changing Plan | Percent Selected
Wanted a plan with a lower monthly premium | 56%
Wanted a plan with a lower copayment/coinsurance | 41%
Wanted a plan with a lower deductible/no deductible | 38%
Wanted a plan offering better quality health care | 27%
Wanted specific benefit coverage that was not offered by my previous plan | 23%
Had a qualifying life event (marriage, divorce, birth of a child, etc.) | 15%
Preferred healthcare provider(s) was not covered by my previous plan | 12%
Moved to a new location | 7%
Other | 7%
To better understand where employees go for information on FEHB plans, those who reported that they considered changing their plan were asked to identify which resources they used for information about plan options.
FEHB plan brochures was the most frequently used resource, followed by OPM’s Plan Comparison Tool. OPM provides a Plan Comparison Tool on opm.gov that allows employees to look at features such as premiums, deductibles, and pharmacy costs for plans available in their geographic region.
Overall, 65% of those enrolled in FEHB agreed the last time they selected or switched health plans, they had enough information to choose the right plan for them. All employees (whether enrolled in FEHB or not) were also asked to identify the top 3 most important factors when selecting a health plan. Two of them related to cost. The results are displayed in the table below.
Factors | Percent Selected
Total out of pocket costs (deductibles, premiums, copays, etc.) | 81%
The providers that participate in the plan network | 48%
Prescription drug costs | 40%
Cost of primary care doctor office visits | 40%
Coverage for specific health conditions | 24%
Quality ratings | 16%
Hospital inpatient charges | 16%
Catastrophic limits | 11%
Coverage for specific services such as gender-affirming care,
fertility benefits, wellness services, etc. | 8%
Availability of mail order pharmacy benefits | 3%
Ensuring quality and affordability are hallmark priorities of the FEHB Program, as OPM understands that health care costs can have a huge impact on the financial well-being of Federal employees. Health care costs often rank as a top financial worry for Americans and according to the Kaiser Family Foundation (KFF) approximately half of U.S. adults report that it is difficult to afford health care costs.
Moreover, 1 in 4 U.S. adults say they or a family member in their household had problems paying for health care in the past 12 months. KFF also reports that 1 in 4 adults have skipped or postponed getting needed health care in the past 12 months due to cost concerns and approximately 1 in 5 adults say they have not filled a prescription because of the cost.
Access to health insurance coverage does not completely mitigate concerns over costs – 4 in 10 insured adults worry about affording their monthly premium and 48% worry about affording their deductible before coverage is triggered.
Comparing FEBS results to these U.S. general population findings, the results are slightly more positive, but generally track closely in terms of the percentage of people reporting that they’ve delayed health care because of the cost.
The FEBS results showed 20% of employees delayed or decided not to get health care within the past 12 months because they could not afford the out of-pocket costs of care. Looking closer at the employees who reported delaying health care, 86% of them also reported being enrolled in FEHB.
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