- The Washington Times - Tuesday, December 3, 2002

Unlike private-sector health plans which are disappearing like an endangered species the Federal Employees Health Benefits Program is here to stay, and participants have until Monday to pick their plan for 2003.
The biggest problem with the FEHBP is that most workers and nearly all retirees never take advantage of annual open seasons, which allow plan members to re-evaluate their coverage and choose from a variety of plans (from chart-your-own course fee-for-service to managed care health maintenance organizations).
Most tend to stay in the same plan, year after year, because they are afraid to change or too busy/lazy to do their homework. This year, everybody should consider some other plans, because premium increases will average 11.1 percent. Some plans will double or triple that increase.
In addition, several plans are cutting back on benefits. There is also the chance that your favorite doctor or hospital is leaving your plan's network.
Some things to consider:
The lowest premiums are found in HMOs. They are great if you like the managed-care concept. HMOs also have the best dental coverage and maternity benefits.
They also have good catastrophic coverage, meaning you would only have to pay between $2,500 to $3,500 in a worst-case scenario.
From a total cost to you basis:
Checkbook's 2003 Guide to Health Plans ranks the available HMOs, based solely on out-of pocket costs, this way: Kaiser, M.D. IPA, Aetna (standard) and Aetna (high option) and CareFirst.
Fee-for-service plans let you chart your own medical course and pick your doctors and hospitals, although you will pay more (usually a lot more) if you go outside of their network.
They also provide coverage worldwide as opposed to HMOs that cover only emergencies if you are out of the area.
Checkbook ranks as best buys: Blue Cross basic, APWU consumer-driven, Foreign Service, Secret Service, Blue Cross standard, GEHA standard and Mail Handlers standard option. Mail Handlers is an excellent plan but its prescription benefit is not as good as the other fee-for-service plans, according to Checkbook.
Postal workers (and employees of the Federal Deposit Insurance Corporation) pay much lower premiums because their agency pays a larger share of the total premium. Most other feds, and all retirees, pay about 28 percent of their total premium.
Once you settle on two or three plans ask someone in your doctor's office what they think. Is your doctor part of their PPO (preferred provider option) network? Does the benefit schedule work for the doctor? Most fee-for-service plans have big networks. Chances are your doctor or dentist belongs to one or more of them.
Each plan brochure has a "benefits changes" page. Read it. Your current plan may be cutting or eliminating a service you want or need.
Pay attention to the catastrophic limit of each plan.
Couples without dependent children who are both feds can save money on premiums by purchasing two single plans rather than a family plan.
Retirees without Medicare should look at Kaiser, Aetna and M.D. IPA, among the HMOs, and at Blue Cross basic, Blue Cross standard, APWU consumer-driven plan and GEHA standard, according to Checkbook.
Retirees with Medicare are in the best shape. They may not have to pay anything for doctor or medical services. Checkbook's best buys for them include Kaiser, Aetna and M.D. IPA, GEHA standard, AWPU consumer-driven, Blue Cross basic and Mail Handlers standard plans.
Coverage offered by the NALC (National Association of Letter Carriers) and the APWU (American Postal Workers Union) are excellent for retirees and workers, Checkbook says. Premiums are only slightly more than other top-rated plans and membership is open to all feds. The NALC and APWU plans get top marks from consumers.
If you want great teeth do this: Brush after every meal, floss regularly, avoid sticky sweets and pick parents with good genes. The best dental benefits in the FEHBP are found in HMOs but they still aren't that great.
Remember you only have a few days left to make a choice. If you do nothing you stay with the same plan. That may be fine. Or it could be a big mistake. You won't know until you comparison shop.
You can check out plans, options and premiums on the Internet. The Office of Personnel Management has an excellent Web site at https://www.opm.gov/insure/.



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