New lawmakers are afforded best U.S. health plan

One of the first, and most important things new members of Congress were told at their welcome-to-Washington orientation is that they are now eligible for what is considered the best health plan in the nation.

That would be the Federal Employees Health Benefits Program.

The FEHBP is a rarity today. A cradle-to-grave collection of health plans that can’t drop you or turn you down because of your age, retirement status, health, bad habits or pre-existing medical conditions. And the government pays a little more than 70 cents of each premium dollar.

Within the next several weeks all members of the giant federal family — current and former feds and current and former spouses — must make one of those potentially life-altering decisions: Which health plan will they choose for the year 2007.

The open season in which they pick their new health plan began Nov. 13 and ends Dec. 11. Experts say that everybody should shop around during the open season and that roughly 20 of every 100 persons in the FEHBP would be better off picking a plan other than the one they are in now.

But if the past is any guide, then only about six of every 100 persons will actually make a switch to a better, maybe lower-cost plan.

There is no magic bullet, no pill, no formula that will help individuals pick the best health plan for their situation. But there are some guidelines to consider. Among them:

• Do you want a fee-for-service plan that lets you pick your doctor, your hospital and help determine the course of your medical treatment. If so, the premiums are usually somewhat higher as are deductibles and co-payments.

• Do you want the convenience of a health maintenance organization that may have a one-stop facility, a more limited choice of doctors who charge minimal co-payments and, through managed care, stresses preventive medicine.

• Your choice will be easier if you check with your primary or favorite doctor to see whether he or she participates in the HMO or is part of the preferred-provider network of the fee-for-service plan.

• If your present health plan premium is going up, check the brochures of a couple of similar plans. See the “changes” section of the brochures to see what, if anything, they have dropped, shaved or improved. In some cases, getting the less-costly basic plan not only costs less but offers equal or even better coverage than the standard or high-option one.

• Consider your travel plans and whether you may be living in a different part of the country part of the year, such as retirees who go south for the winter. For those people, HMOs are not the best choice. Although they have good benefits and low premiums, they will not cover you (except for emergency situations) outside their generally limited geographic area.

• Ask your doctor (or someone in the office) to take a look at the brochures of the plans you are considering. See whether they work for him or her, and if they are going to be in that plan’s network throughout 2007.

• Check out the so-called HD (high deductible) plans. They charge lower premiums but as a trade-off you must pay more out of pocket up to the maximum deductible limit. It’s like car insurance that offers lower premiums if you have a $500-deductible plan than if you have a $200-deductible plan.

• The HD plans mentioned above work best if you have a health savings account. This allows you to use pre-tax money to help pay the deductibles, which next year will be around $1,100 for self-only coverage and about $2,200 for family coverage.

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