Walton Francis, for Consumer Checkbook
Every year Consumers’ Checkbook publishes a detailed comparison of FEHB plans for federal employees and annuitants. The Guide provides total cost comparisons that take into account both premium and likely out-of-pocket expenses among health plans. These comparisons consider the age, family size, health status, location, agency, and pay systems of individual employees.
We also cover all plan changes. There isn’t a lot of hot news this Open Season, but one new thing is that telehealth is probably here to stay as a way to communicate with health-care providers without a physical visit. This is a great advance in all FEHB plans since the hassle of a physical visit can be avoided while making sure you and your physician keep up-to-date on your health conditions.
The results of our analysis show that major savings opportunities abound, and data on movement among plans shows that these savings are frequently unrecognized and ignored. How many employees know that the United, CareFirst, GEHA, and MHBP high deductible plans will on average save enrollees $3,000 or more compared to the half-dozen most costly plans? How many employees know that the GEHA Elevate and Blue Cross FEP Blue Focus plans even exist, let alone offer almost equally spectacular savings?
The First Step. Focus on your family and the plan you are now enrolled in.
· Think about your family’s medical situation—are there going to be any major changes that will affect your medical needs next year? This could be something you plan for, like having a baby or getting knee surgery, or some change in your health condition that may lead to expensive future treatments. How well will your current plan handle these?
· Don’t assume your plan is unchanged—benefits may be worse and premiums could be more, your doctors may have left the plan, or your expensive drug may not be on the low-cost part of the formulary.
· If you do nothing else, download a PDF copy of your plan brochure to make sure nothing has changed that is important to you. You can get it from the OPM website, from the Checkbook website, or from the plan website. Just turn to Section 2 of the brochure that summarizes changes to scan for any benefit changes that may affect you.
· Medicare enrollees need to be aware one more key place to check: changes in Medicare coordination benefits are going to show up only in Section 9 Coordinating Benefits with Medicare, not in the list of changes in Section 2 of the plan brochure.
· All enrollees should check for the pages near the end of Section 5 titled “Non-FEHB Benefits Available to Plan Members.” That is where you will find the unofficial dental benefits, the dollar rebates for “wellness” actions, the reduced price or free glasses or contacts, and other benefits you never knew you had.
· If you have a doctor or doctors you want to keep, call the doctor’s office to make sure that he or she will still be a preferred provider next year in your current plan. While you’re at it, ask about other networks, such as Aetna, Blue Cross, and United.
The Plan Choice Step. Now you are ready to consider other plans that might save you money through better benefits, lower premiums, or both.
The entire purpose of Open Season is to give you plan choices. If you are willing to take on just a little more work, there are a few additional steps you can take that can lead to thousands of dollars in savings.
· Even if you like the insurance carrier you have now, all the major carriers offer multiple plans: in the DC area, Blue Cross has 3 plans, Aetna has 8 plans, GEHA has 5 plans, United has 6, and Kaiser has 3.
· You first have to open your mind to something you may not realize: there are dozens of plans and many of them are plans you may never have heard of. In the DC area, there are about 40 available plans. A half dozen of these are new in the FEHB program either this year or in the last couple of years. One or more of these may well be far better for you than the plan you are now enrolled in.
· Both OPM and Checkbook provide plan comparison tools. These tools show you all available plans in your metro area or nationally, and give you short indicators about a few dozen key ways that plans differ, such as premium, deductible, copays for doctor visits, hospital admission fees, and many coverage features.
· Additionally, CHECKBOOK actually compares plans for likely cost to you next year depending on whether your medical needs are low, high, or average. We estimate that MOST families can save $2,000 or more by switching from a high-cost plan to a lower-cost plan, and show you how much each plan is likely to cost families like yours.
Quick Picks for FedWeek Readers. Here are some examples of plans that Checkbook rates as good buys for 2021.
· For younger employees and those of any age whose usual health-care expenses are low, the low-cost premiums and Health Savings Accounts of the high deductible plans from United, CareFirst, GEHA, and MHPB make them excellent options to consider.
· High deductible plans are especially valuable because they are long-term investment choices, something like an IRA on steroids. Health Savings Account (HSA) contributions paid by the plans go into your account tax-free, grow tax-free from your investments, and come out tax-free if used for health care. These accounts stay with you for life and can be augmented by enrollees up to a total of $3,600 single and $7,200 family contributions per year (including the amount paid by the plan).
· Consumer-driven plans rank high as cost savers: NALC CDHP, APWU CDHP, and Aetna Direct CDHP.
· For those who would rather stick with conventional insurance, the GEHA Elevate and Elevate Plus plans, and the Blue Cross Basic and FEP Blue Focus plans, are better buys than the higher-priced options from these companies. Savings for self-only or any family size will in most cases be $1,000 or more and for those currently enrolled in the highest cost plans $2,000 or more.
· For those willing to join an HMO, all three Kaiser options and the United Choice Primary and Aetna Open Access Basic are big money savers in the same $1,000 to $2,000 range.
The choices above are excellent for any age group, from twenty-somethings to annuitants who haven’t reached Medicare eligibility, and for family sizes ranging from self only to families of five or more. But exactly which ones are best for a particular family will depend on factors like health status and use of expensive prescription drugs.
For annuitants enrolled in Medicare, things get more complicated. Each health plan has a different way of reducing costs for those with Part A only or with both Parts A and B, either by reducing hospital cost-sharing, physician cost-sharing, or in some cases paying part of the Part B premium. The very best buys are found in little-known offerings from Aetna, United, and Kaiser. In some of these carriers’ FEHB plans, annuitants with Parts A and B can simultaneously join a special Medicare Advantage plan open only to FEHB enrollees in which you pay nothing or almost nothing for hospital or doctor costs, and in which the plan pays all or almost all of the Medicare Part B premium.
The Ways to Save Never End. Here are a few more things to consider from among many presented in the Guide:
· Many plans offer dental benefits, including not only standalone dental plans, but also both official and “unofficial” dental benefits in the health plans. Many local HMOs, such as MD IPA and the CareFirst and Kaiser options in the DC area, and a few national plans such as NALC, outperform the FEDVIP dental plans in all but the most expensive cost scenarios.
· There is an incredibly easy cost-saving strategy that most forget. Suppose you have a doctor that you really, really need to see twice a year, who isn’t in the network of any low-cost plan. Do you really need to pay thousands more in premium to get this doctor? No you don’t—just pay cash for those visits. Let’s see, which is better: paying $2,000 extra in premium and $60 in copays for two visits, or paying nothing extra in premium and $250 in charges for two visits? This strategy works especially will in high deductible and consumer-driven plans with special saving and spending accounts.
· As a smart employee enrolled in a traditional health insurance plan, you do plan, of course, to set up a Flexible Spending Account this Open Season, set aside up to $2,750 of your salary to be tax-free, and save about a fourth of that amount in reduced Federal, State, and OASDI taxes. Oh, that special doctor you need to see doesn’t cost $250, but only about $160, if paid from your FSA.
· You do of course know about the five-year rule for enrollment before retirement, as well as the fact that if you die while enrolled in a self-only option your spouse will lose FEHB insurance forever?
Walton Francis is a health insurance expert and a member of the National Academy of Social Insurance. He is the principal author of Checkbook’s Guide to Health Plans for Federal Employees. Many agencies provide free access to Checkbook’s Guide to Health Plan for Federal Employees. Click here to see a list of participating agencies. Individuals can also purchase the Guide at GuidetoHealthPlans.org and save 20% by entering promo code FedWeek at checkout.