When it comes to health care, federal employees are unique among most professionals in the United States. Rather than be restricted to a single provider, they can choose from a variety of insurance options, and they can change their plan every year, if they desire.
And yet, most feds choose to keep the same insurance they held in the previous year, some without considering the value of other offerings. If you ask Reg Jones, former head of retirement and insurance policy at the Office of Personnel Management, that can be their biggest mistake.
“Most employees stay with the plan that they have for one of two reasons: one, they are satisfied with it; second, they just don’t know what to do, so it’s safe to stay where they are,” Jones said.
“Some of the people who are in those programs are quite old and may no longer have the ability to research. But the rest of the people should start as soon as open season begins, so they can look at the plan options and prices.”
Even among plans with almost the same coverage, the prices can increase or decrease based on whether that insurer happens to have largely healthy members. A different insurer with the same offerings may be able to offer feds a better deal.
Employees generally have the option to choose from more than 250 health care plans each year, with just over a dozen offered nationwide, and can select a plan for either just themselves, their whole family, or themselves plus a single additional family member.
Evaluating those plans should involve two stages of reflection, according to Jones.
“Federal employees need to look back at the year that’s gone by, and maybe even further, and ask themselves whether the insurance that they have now is providing them with the support that they need — meaning are they being covered for their bills and to what extent — and is that the amount they were promised when they signed up for the program,” said Jones.
“Look at yourself now and say, ‘Is there anything coming up in my future that I know is going to happen?’”
Feds typically fall into four categories, according to Jones:
- Generally healthy employees whose priority is saving money over getting expansive coverage;
- Feds who don’t expect any major health problems but have families that may require standard coverage for such health care services as children’s shots;
- Employees that have a chronic condition or planned medical expense that can influence the kind of coverage they’ll need; and
- Generally older employees that don’t have ongoing medical expenses currently but expect more health coverage could be needed eventually based on family history or statistics.
According to Jones, employees that have expected medical expenses for the upcoming year — like a planned surgery or pregnancy — are “in the best position to analyze plans.” They can adjust upward for one year to a more expensive plan that offers more coverage and then adjust back down the next year.
But looking for simply the lowest price available also presents a dangerous pitfall for employees, as those who sign up for such an option could be surprised by the costs of that plan down the road, when they have to put money toward a high deductible or aren’t covered for an unanticipated medical expense.
According to Jones, a modest price reduction may also not be worth the concessions an employee may have to make, like giving up a doctor that they know and trust but is no longer included in network.
“It makes very good sense” to go to your doctor and ask about the plans you’re considering, to ensure that his or her practice participates, Jones said.
Also, “you want to talk to others — if you can find them — who are already using that plan, to learn about their experience and their satisfaction.”
In recent years, federal employees have had more specific options for covering their families under the federal system. Rather than only being able to cover just themselves or a full family, feds now have the option to include only one family member on their coverage in cases where, for example, the employee is married with no children or is a single parent.
That said, just because a fed fits within a new plan type does not mean they will automatically save money by signing up.
“Because of the way that the formula works to establish the premiums, there are freak cases where self plus family can be cheaper than self plus one,” said Jones.
Avoiding the pitfalls and finding the right plan requires feds to simply put in a baseline effort.
“It’s work … it’s work and you have to do it, but you can do it with the assistance of calls to the plan you’re considering to ask them questions,” said Jones.
“Open your eyes, talk to other people in the federal employee health benefit program and look over materials that OPM will be providing. And give it at least a minimum scan. You don’t have to do a 10-hour analysis to make up your mind.”
OPM also offers an online plan comparison tool for feds to use to explore their options, based on employment type, location and healthcare needs.
Open season for 2020 health coverage will run from Nov. 11 to Dec. 9, 2019. Employees can also enroll in vision and dental insurance during that time.
Jessie Bur covered the federal workforce and the changes most likely to impact government employees for Federal Times.