As federal employees and retirees consider which health plan to choose during this year's open season - Nov. 12 through Dec. 10 - experts said they should make sure their doctor, hospital or necessary specialists are in the network of the plan they sign up for. (Getty Images)
As federal employees and retirees consider which health plan to choose during this year’s open season — Nov. 12 through Dec. 10 — experts said they should make sure their doctor, hospital or necessary specialists are in the network of the plan they sign up for.
Bill Breskin, vice president of government programs for Blue Cross and Blue Shield, said that some Federal Employees Health Benefits Program enrollees end up switching plans during open season because they know they will have to go to a different doctor or hospital in the next year.
But some feds switch plans to lower their premiums, and they realize too late that the new plan doesn’t cover the doctor they need to go to, forcing them to spend more in out-of-network costs.
Breskin said enrollees should be careful when making such a change.
“How big is the network? Can I see my own doctor, or get to the specialist I need?” Breskin said. “This is the X factor, which is huge.”
Karen Schuler, marketing director for Government Employees Health Association (GEHA), said feds should also consider how much their prescription drugs and other out-of-pocket expenses will cost them. GEHA’s website offers an online tool that helps them estimate those costs, she said.
Walt Francis writes the annual Checkbook guide to the various FEHBP plans, which he said can help an enrollee compare plans and figure out which will offer him the best deal.
And Schuler said online tools offered by the Office of Personnel Management and PlanSmartChoice can help enrollees make a decision. Such comparisons can allow someone to see which plans offer features that he doesn’t really need, and to feel more comfortable choosing a less-expensive option.
“More people are using online comparison tools to put plans side-by-side,” Schuler said.
Schuler also said that FEHBP enrollees approaching Medicare-eligibility age should look to see how various plans coordinate with Medicare. This could save someone from having to pay co-pays or deductibles, Schuler said.
Federal Times talked to five FEHBP enrollees — four who plan to remain with their existing health insurance plans in 2013 and one who intends to switch to a different plan.
Here is what the five had to say as to why they are standing pat or switching, and how they’ve gone about making those choices:
Pam Stern, retiree
Stern, 55, has a dilemma. She retired on May 1 as a Defense Department contracting officer in Albuquerque, N.M., after 37 years with the government. She is inclined to abandon Lovelace Health Plan, her HMO since she came over from Blue Cross in 1979. The HMO, in a dispute, has separated from ABQ Health Partners, where she has long seen three doctors.
“I have to decide what’s more important to me,” Stern said, but she leans toward keeping her doctors and returning to Blue Cross, which also will cover her if she needs care out of state.
But Lovelace is making a pitch to keep her business — by lowering monthly premiums from $228 to $119 and promising to help her find new doctors.
Bob Good, retiree
Good, 59, weighed all the options and has decided to stick with the status quo. He retired from his job as an Animal and Plant Health Inspection Service veterinarian in Annapolis, Md., on May 1, after 34 years with the agency. He had chosen either Blue Cross and Blue Shield or M.D. IPA, a health maintenance organization plan, during those years. He switched back to Blue Cross’ lower-cost basic family plan this year because he faced paying $150 under M.D. IPA for a three-month supply of Humira, medicine for his wife’s rheumatoid arthritis, but only $120 with Blue Cross.
In choosing a plan, he analyzes factors including premiums, co-pays, deductibles, scope of benefits, freedom to choose the several doctors he sees, complaints about insurers by policyholders, and limits on payments for catastrophic illnesses. He uses the online version of the Checkbook guide — “a real bargain” at $9.95, he said.
His thoroughness is unusual among the 4 million federal enrollees in health insurance plans. “Most of them won’t take the time to do their homework,” sometimes losing valuable benefits or paying more than need to pay, said Checkbook author Francis.
Good expects to stick with Blue Cross basic in 2013, seeing his rate go up $14.28 monthly, or 5 percent, to $299.70. “I’m always open to the fact that something substantial might have changed,” he said, ”but nothing like that has occurred.”
Most federal employees and retirees are expected to stick with their 2012 plans next year, mainly because premiums are moderating.
The average plan rate hike in 2013 is 3.4 percent, down from this year’s 3.8 percent increase.
Any increase is “pretty tough for some people,” Francis said, since federal employees’ pay scales have been frozen since Jan. 1, 2011, and will not be raised at least through March.
Recognizing that, “we have tried very hard to hold the line on our costs and rates,” said Jena Estes, vice president of federal employee programs for Blue Cross and Blue Shield.
Some co-pays have been reduced. “We don’t want co-pays to be a barrier” to choosing Blue Cross, Estes said.
Lee Tomlin, retiree
Tomlin, 78, who retired in 1994 as chief property manager in Denver for the Bureau of Land Management, is impressed with Government Employees Health Association (GEHA)’s operation and modest rate increases.
The insurer retains nearly all of its income to pay claims, which are processed in 10 days, Tomlin said. Providers under GEHA are hard to find, but “they have improved probably 200 percent over the years,” he said.
He chose the standard family plan for 2012, and his monthly premium will increase a “reasonable” 5 percent to $221.41 in 2013. “I look at the premiums every year,” he said, but “it would really require a serious crisis” involving GEHA to cause him to look elsewhere.
Elvis Morales, Justice Department
Morales, an auto mechanic who maintains a Justice agency’s vehicle fleet in Baltimore, expects to keep his Blue Cross basic family plan in 2013. He’s worked for the government for five years, opting for Blue Cross for four years of the five, switching to GEHA in 2011 and then switching back this year.
A single father of three young children, he’s OK with his premium: $131.73 biweekly this year, increasing 5 percent to $138.32 in 2013. The premium and lower co-pays “are the big reasons I did go with” Blue Cross, Morales said.
Blue Cross covered more charges for a hospital stay he required, for example, and while some co-pays were higher than GEHA co-pays, others were lower — $50 for X-rays under GEHA, nothing under Blue Cross, for example, he said. Overall, “I ended up paying more out of pocket in the long run,” under GEHA, he said.
For 2013, “I’ll entertain other insurers, but I’m 95 percent sure I’ll stick with” Blue Cross, Morales said.
Rebecca Tittle, Navy
Tittle, 56, thanks her lucky stars that a switch from Blue Cross to Kaiser Permanente in 2011 to take advantage of a lower premium turned out far better than she imagined: Kaiser’s coverage and handling of a serious health event that summer was so generous and skillful that she’s effusive with praise.
A 56-year-old Navy labor relations officer in Washington and single mother of a 24-year-old daughter, Tittle had a severe viral coughing jag that summer, including fainting, and was rushed to the hospital, where she spent three days, and was off work for a full month.
Kaiser covered her hospital expenses, all tests and other costs — even a $100 ambulance ride from her office.
“I couldn’t believe my good luck,” she said. Otherwise, “my budget plans would have been totally defeated.”
The premium rate for her family high option plan this year is $170.01 biweekly, rising 4 percent to $176.20 in 2013.