Members of Congress receive the same basic health insurance coverage as rank-and-file federal employees, although lawmakers also have access to other services not available generally, according to a new internal congressional report.
The Congressional Research Service report, dated May 3, addresses an issue that commonly arises during debates over health insurance policy and over pay and benefits for federal employees and members of Congress.
Nearly all federal employees, including elected federal officials, are eligible to participate in the Federal Employees Health Benefits Program. The FEHBP offers several nationwide plans plus about 200 regional health maintenance organization plans. All cover hospital, surgical, physician, mental health, prescription drug, emergency care and certain other benefits, although exact terms vary.
FEHBP also has no requirement for medical examinations on enrollment, no pre-existing condition exclusions or waiting periods, the choice of self-only or self-and-family coverage, and an employer contribution toward premiums that averages about 72 percent of the total cost. Enrollees, including members of Congress, pay the balance of the premiums, plus certain out of pocket costs.
CRS said that participation rates among current and retired members of Congress are not publicly available.
Current members of Congress, unlike other federal employees, also are eligible to receive health care services from the Office of the Attending Physician in the Capitol for an annual fee, currently $563, regardless of whether they are enrolled in the FEHBP. CRS said that services from that office include routine exams, consultations and certain diagnostic tests, but not vision or dental care; prescriptions can be written but not dispensed.
“Members of Congress are also authorized to receive medical and emergency dental care at military treatment facilities,” CRS said. “There is no charge for outpatient care if it is provided in the National Capital Region. For inpatient care, members are billed at full reimbursement based on rates set by the Department of Defense. Outside the National Capital Region, charges are at full reimbursement rates for both inpatient and outpatient care provided to Members of Congress.”
FEHBP insurance may cover those expenses after a deductible or copayment is met, the report said. Members pay out of pocket for expenses not covered by FEHBP or other insurance. Former members and dependents are not eligible for care at military hospitals, it said.
Persons covered by FEHBP, including House and Senate members, can continue that insurance into retirement if they are eligible for a federal annuity and if they have been continuously enrolled for the prior five years. The minimum amount of service needed to qualify for a federal retirement benefit is five years; an individual retiring with that little service would need to be at least age 62. Other standard combinations include age 55 with 30 years of service or age 60 with 20 years, although other combinations apply in certain circumstances.
Retirees must continue paying the enrollee share of the premiums and other costs. While premiums are the same as for active employees, FEHBP coverage effectively becomes more expensive after retirement because active employees can pay their premiums with pre-tax money but retirees can’t.
Current federal employees and members of Congress, although not retirees, can set aside money pre-tax in flexible spending accounts, which can be used to pay some out of pocket costs.
Those who are eligible for FEHBP, including eligible retirees, also typically are eligible for supplemental vision and dental coverage whose costs are paid entirely by enrollees. The same applies to a long-term care insurance program.
In addition, all federal employees including legislators pay the standard Medicare payroll tax and become eligible for benefits under that program under standard rules.
The report added that under the 2010 health care law, members of Congress and certain staff members will be required to leave the FEHBP and get their health insurance coverage under the state-based exchanges envisioned by that law. That provision will not be effective until 2014 at the earliest.