- The Washington Times - Monday, December 1, 2003

Federal employees and retirees have only five more shopping days (until Dec. 8) to pick their 2004 health plans.

If you are enrolled in a plan and do nothing, then you will stay in that plan — even though its premiums probably might have jumped sharply, its benefits may have been reduced, or your favorite doctor may no longer be in that plan’s network.

If you are eligible for the Federal Employee Health Benefits Program (FEHBP) and you don’t belong, look in the mirror and ask yourself why not? It’s the best group plan in the nation, and one of the few that welcomes retirees and older people.

It’s cradle to grave, meaning you can’t be kicked out or denied coverage because of age, health or a pre-existing medical condition. But to carry the plan into retirement — for yourself, your spouse and, in some cases, dependent children — you should have been enrolled in the FEHBP for the five years immediately prior to retirement.

So if you are piggybacking on your private sector spouse’s health plan, strongly consider signing up for the FEHBP (pick the plan with the lowest premiums). Think of it as insurance for when your spouse’s private plan drops him or her, or your spouse drops you. It happens.

There are two sources for top-notch, no-strings advice on the FEHBP. They are Walton Francis of the Washington Consumers’ Checkbook Guide to Health Plans for Federal Employees and Ken Glass of the National Association of Retired Federal Employees.

Checkbook publishes and sells a guide each year (available at most newsstands). Many federal agencies have the guidebook on their Web sites. NARFE, based in Alexandria, does an excellent job informing members (active as well as retired feds) of their best buys. The Office of Personnel Management’s Web site (www.opm.gov) shows the plans and the 2004 premiums.

All the federal health plans (Washington-Baltimore area feds are eligible for several fee-for-service plans and HMOs) are good. But some are better for you depending on what you want, what you can afford, etc.

The primary purpose of a health plan is to protect you from catastrophic medical or hospital bills. That’s why it is important to check the limit-to-you amount of each plan. That’s the maximum you would have to pay out of pocket if the worst happens.

Since time is wasting, here’s a thumbnail sketch of the best buys from Walt Francis. This ranks plans by the lowest total cost to you (in terms of premiums as well as out-of-pocket costs).

The best buys for most people, according to Mr. Francis, include most of the HMOs — which will cost a single person $1,300 a year, a family of three $2,700 and a retired couple about $4,200 in an average medical year.

Best buys (if you are eligible) are the Foreign Service PPO (preferred provider) plan, the Association PPO plan, the SPEC Agents Mutual Benefit Association PPO plan and the Secret Service plan. If you don’t know what agencies SAMBA and Association represent, you probably aren’t eligible to join them. This year some Homeland Security and Defense Department workers are, for the first time, eligible for the Foreign Service plan.

Best buys for federal retirees with Medicare A & B (provided they use preferred providers) are most of the HMOs, the GEHA Standard PPO, the American Postal Workers Union consumer-driven plan, the Mail Handlers Standard PPO, the Blue Cross basic PPO, the Blue Cross Standard PPO and the National Association of Letter Carriers PPO. Although the Mail Handlers, APWU and NALC plans are sponsored by postal unions, any fed or retiree can join them by paying a small “associate member” fee.

There are thousands of people who belong to the FEHBP who have never worked a day for the government, maybe never set foot inside a federal agency. They are eligible because they are the ex-spouses of feds and retirees whose divorce decree gives them access to the federal health plans.

Unlike federal workers and retirees, who pay about 23 percent of the health plans’ total premiums, the ex-spouses (or their former spouse) must pay the full freight. That can range from $3,500 a year for a single person in the Aetna standard plan and $7,900 for a family of three to as much as $5,200 for the Blue Cross standard plan (for a single person) or up to $11,600 for a family of three.

For those full-premium payers, Mr. Francis recommended Aetna standard, Kaiser, Aetna Consumer Driver, the GEHA standard PPO, the Mail Handlers standard PPO, the Blue Cross basic PPO, the APWU Consumer-driven plan and the Blue Cross standard PPO.

Good hunting

Flexible-spending accounts

The deadline for the FSAs, which let you set aside a pretax pot of money to cover otherwise uncovered medical, dental and drug bills, has been extended to Dec. 15. That’s to give folks the time to sign up for the new, higher limit FSA. Details on it will be furnished next week.

Mike Causey, senior editor at FederalNewsRadio.com, can be reached at 202/895-5132 or mcausey@federalnewsradio.com.

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