It’s Open Season! I’m sure that some of you (like me) greet this time of year with dread, while others find it easy enough to re-enroll in your usual plan. This year, the Federal Employee Health Benefit (FEHB) Program has 257 available plans (although you might not have access to all of them depending on your agency, location, etc.), a huge increase over the past three years. Of course, you might not qualify for (or need) many of the plans out there, but the vast number should serve as an indication that choosing what’s right for you is no small task.
Whether you like your current plan or not, it’s highly recommended that you spend some time researching your plan options before the December 8 deadline. Each year, large or small (and seemingly insignificant) changes are made to health insurance plans, and depending on your requirements, these could have a major impact on your plan price and quality.
Here are some things to consider before choosing your plan:
Are you happy with your current plan?
If you are 100% satisfied with your current health plan, great! But, before you finalize your enrollment for 2015, take a quick peek at the plan and make sure that no changes were made. This includes ensuring that your physicians, dentists, eye doctors, etc. are all still participating in the plan. Also think about whether you have too much coverage, and look at similar plans (both in cost and coverage) to determine whether there might be a better option for you.
If you aren’t happy with your plan, a great place to start when choosing something different is to speak with others about their plans—talk to your friends, your co-workers, other family members—and get a sense of what type of coverage they have, and what they like and dislike. Obviously, what works for one person might not work for everyone, but if your neighbor hates his plan, see if you can figure out whether you should avoid it too.
What is the actual cost?
Choosing health insurance isn’t like buying a couch where you know exactly what you’re getting for a set price. When you compare health plans, you’ll notice a lot of variance in the premium, co-payments, co-insurance, and deductibles (one thing you’ll readily notice is the 3.2% premium increase over 2014, the smallest increase since 2006, in part because of changes made by the ACA). Co-pays, co-insurance, and deductibles can vary even depending on the type of service you receive within a plan. For example, you might have a smaller co-payment at your primary care physician, but if you visit the emergency room, you’ll pay far more.
While premiums will vary from plan to plan, it is important to note that a higher premium doesn’t necessarily mean better coverage, and vice versa. There are many different factors that go into the premium, so don’t automatically rule out high- or low-premium plans.
What is important to you?
This varies by person. Some prefer like high-deductible, consumer-driven HMOs, which, while more expensive on a monthly basis, often offer better catastrophic coverage and a wider range of coverage. PPOs, on the other hand, are beneficial if you always use an in-network doctor.
How much do you spend, on average, and how much do you anticipate spending?
It’s relatively easy to tally up year-to-year spending (or at least an approximation) to determine how much you spend each year and what services you use. This is a good baseline to determine whether you have the appropriate coverage for your needs (and your family’s needs). However, it is also important to think about your current situation. Are you (or is your spouse) pregnant? Do you have young children? Children who will be leaving the plan? Are you planning to undergo a major procedure this year? All of these factors need to be considered when you look at the different coverage options. Some of this, obviously, involves guesswork. Everyone tries to stay healthy, but you never know what might happen. But in some cases, you can make an educated estimation of your needs if you know what you plan to do, medically speaking, in the coming year.
Do you want a flexible spending account?
FSAFEDS is available if you’re interested in putting some pre-tax money aside from your paycheck into a flexible spending account. You can use this money for a number of qualified medical expenses including co-pays and prescriptions. Starting in 2015, the annual minimum has been lowered to $100, and employees will be able to carry over $500 in unused funds to the following plan year.
Where can I get more information?
There are a number of tools available to help make your decision easier. A few include:
Consumers’ Checkbook: Their guide provides excellent information on each plan including costs, coverage, overall quality, and tips on making a decision. There is a fee to view the guide, however, many federal agencies offer free online access for their employees, so be sure to check with yours.
PlanSmartChoice: This online service compares FEHB services and prices, and can help you get a better estimation of what you can plan to pay each year under the different insurance options.
OPM has a variety of helpful tools on its Open Season website, including plan brochures, a video overview of benefits, plan overviews, a FSA calculator, and FAQs.
OPM also offers a guide that includes information on plan satisfaction. Starting on page 18 of this OPM guide, you’ll find member satisfaction scores for a variety of FEHB plans.
Also, be sure to check out the GovLoop guide to choosing the right health insurance plan for you.
I liked your article and the advise but it is a little miss-leading. I’m not sure where you are getting your information from but in Tidewater Virginia All Federal Employees with OPTIMA Health Care were served notice we were loosing our health care providers in the area. When I called them, they told me it was due to the Affordable Health Care Act. I called my senators’ office and I was told to sign up on an exchange! When I went to look at other health care providers I discovered that there were only a small handful of companies, 5-8, still doing business in Tidewater Virginia. So you number of 257 may be true collectively across the country but it not the case for Virginia. I suspect this will be the case with all Federal Employees in time to come as the “Affordable Health Care Act” continues to be rolled out as planned and declared by its’ Architect, Jonathan Gruber.