- The Washington Times - Monday, November 15, 2004

With all due respect to the importance of the presidential election, the most important vote many federal workers and retirees will cast this year concerns their health insurance. The hunting season, when workers, retirees or their survivors pick their 2005 health plan, ends Dec. 13.

The vast majority of retirees, and most active-duty civil servants, do nothing during the open-enrollment period. They stick with their current health plan even though its premiums may be going up and, more importantly, coverage that they count on will be downsized in 2005.

Most people focus on premiums. Premiums in the federal health program (FEHBP) are going up an average of 7.9 percent this year, compared with an overall rise of more than 11 percent for premiums in the private sector. But some of the federal health plans are going up much more. That, plus benefit changes (which are in the plans’ 2005 brochures), require feds to do some homework.

Walton Francis, author of the Washington Consumers Checkbook Guide to Federal Health Plans, says all of the plans are good.

But “good” won’t be good enough for people with special health needs and/or lots of children. Picking the “best” plan for you — in combination with a pretax Flexible Spending Account to pay for uncovered medical bills — can save you thousands of dollars next year.

If you don’t like to make decisions, the FEHBP open-season period is something of a chore. Postal workers in the Washington area, and retirees, are eligible for a total of 21 health plans. That’s a lot of brochures to read.

The plans include local HMOs (Kaiser, MD IPA, CareFirst Blue Choice, Aetna and Coventry), or fee-for-service (nationwide) plans such as Blue Cross, GEHA, APWU, NALC, and the Mail Handlers plans, which are open to all workers and retirees. There are also various plans such as SAMBA, Foreign Service and Rural Letter Carriers, that are open only to select groups of workers. For example, if you think SAMBA is a dance (actually, it’s for federal law enforcement personnel), it isn’t open to you.

Things to consider when looking for a health plan, according to Mr. Francis are:

• Your health and that of any covered family members.

• Changes in premiums and benefits.

• Check the brochures of at least one or two other plans, in addition to the one you are in now.

• Consider the new “high-deductible” health plans, particularly if you are young and healthy.

• Check out the Flexible Spending Account option. It allows you to set aside money on a pretax basis. That account can be used for a variety of medical items — such as nonprescription drugs, eyeglasses, etc. — that are not covered by your health plan. You can put up to $4,000 in your account and another $5,000 for a dependent account.

Checkbook ranks health plans by the total cost to you. That is the amount that you will pay out in premiums for each plan plus your likely out-of-pocket costs. Using that, it recommends you check out most of the HMOs, Blue Cross Basic PPO, Aetna HDHP, APWU Consumer Driven, Blue Cross Standard PPO, GEHA Standard PPO, Mail Handlers HDHP and the NALC PPO. For a single person, premiums and estimated out-of-pocket costs range from $1,500 for the HMOs and Blue Cross Basic to $2,010 for the NALC plan. A family of three would have about double that total cost.

• Retirees: For federal-postal retirees with Medicare Parts A and B, the best bets are most of the HMOs, GEHA standard and Blue Cross Basic.

• Dental benefits: The best buys for this elusive feature are the Aetna Consumer Driven plan, MD IPA, Aetna Open Access, Kaiser High Option, CareFirst, GEHA standard and Blue Cross standard.

• Full premiums: uncle Sam pays about 72 percent of the total premium for federal workers, retirees and their survivors. But there is one group — mostly, the ex-spouses club — that can belong to the FEHBP even though they never worked for the government. The downside is that they pay the full premium: The employee share and the government share.

That brings their premiums and out-of-pocket costs to anywhere from $3,700 for a single person or $8,600 for a family of three in Aetna’s Open Access Basic plan to as much as $4,800 for a single person in the Blue Cross Basic PPO to nearly $11,000 for a family of three in the same plan.

Mike Causey, senior editor at FederalNewsRadio.com, can be reached at 202/895-5132 or [email protected]federalnewsradio.com.

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