- The Washington Times - Tuesday, November 15, 2005

Active and retired federal workers in the Washington area — as well as their spouses, survivors and in some cases former spouses — have 27 days to pick their 2006 health plans.

They have dozens of choices with a variety of premiums, and Uncle Sam on average will pay roughly 70 percent of that total premium.

Feds, retirees and dependents cannot be denied coverage by any of the plans because of pre-existing conditions such as heart disease, AIDS or pregnancy, and best of all, they are covered for life.

Unlike many private companies that deny retirees coverage, limit their benefits or increase their premiums, the federal program is the same for a healthy 19-year-old fed as it is for a 99-year-old retiree.

The only downside to the federal program is sorting through all the options. They include fee-for-service plans, which allow you to pick your doctors and the hospital you wish to use; health maintenance organizations, which practice managed care; and a new breed of high-deductible plans that, like HMOs, offer lower premiums than traditional fee-for-service plans.

The Washington Consumers’ Checkbook guide to 2006 federal health care plans estimates that workers and retirees can save hundreds of dollars in premiums and out-of-pocket costs by picking the plan that is best for them and their families. In many instances, an HMO will be less costly in premiums and fees than a fee-for-service plan. “Basic” coverage will cost you less in some cases than the “standard” option in a plan.

But you’ve got to study to win, and most people don’t do that.

The typical federal worker, and even more so the typical retired fed, waits until the last minute and then makes a decision not to make a decision. They stay in the same health care plan year after year, even if premiums rise more than average and even if benefits — which many people don’t understand until they get hit with an unexpected bill — have declined or changed.

Although most federal workers and especially lower-income retirees focus on premiums alone, premiums tell only half the story. The single most important item, said Checkbook insurance adviser Walton Francis, is catastrophic coverage. That is the stop-loss line, or the amount you must pay out of pocket for a catastrophic illness or accident before the insurance plan takes over virtually all of the costs.

For a family of two, those limits range from about $6,600 for Kaiser High Option, an HMO, and Blue Cross Basic, a fee-for-service plan, to more than $15,000 for some other plans.

Single consumers have a much easier time shopping for health insurance than retired couples or families with children. The odds of needing medical or dental services rise with the number of people covered as well as with age. A couple of plans in the federal program are open only to CIA, Foreign Service or federal law-enforcement personnel.

Navigating the open season isn’t the toughest thing you have done this year, but it could be one of the most important. So stick with us and in upcoming columns we will list the “best buys.”

At the end of the open season, Dec. 12, if you decide to stick with your current health care plan, that’s fine if you have studied some alternatives. But if you sleepwalk through the open season, there is a good chance that at some point next year you will get a rude awakening.

Plan now so you don’t pay too much later.

• Mike Causey, senior editor at Federal News Radio AM 1050, can be reached at 202/895-5132 or [email protected]

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