Moderator: Good afternoon and welcome to Viewpoint with our guest, Bill Smith. Bill, thank you for joining us. What should FEHB enrollees be thinking about as they decide whether or not to change plans and what does NARFE do to assist?

Bill Smith: There is no way of being certain which is the best plan for you and your family. Health insurance is a gamble. No one knows how much or what kinds of medical care they will need next year. You should review the kinds of medical care you and covered members of your family have used in the past few years. That should give you a clue as to the kinds of care you'll need in the future, but it won't help to predict unexpected illnesses or accidents.

During the open season, study the material given to you by your agency or OPM, especially the Plan Comparison Chart and/or the Open Season Health Benefits Guide for retirees. Don't make your decision based on the chart. Benefit structures and their brochure descriptions vary, and information in the Chart can be misleading.

The December issue of NARFE's Retirement Life magazine, which members will receive well before the open season closes, will have a run-down of individual fee-for-service plan changes and a special section entitled "Fee-for-service Prescription Changes for FEHB - Medicare enrollees".

Moderator: Are there benefits changes that they should be on the lookout for this open season?

Bill Smith: The major change for FEHB fee-for-service plans next year is that Medicare enrollees will have to pay copayments (ranging from $5 to $20) for Mail Order Prescription Service. Prior to this time, FEHB/Medicare enrollees in most of these plans did not pay a copayment. Six of the seven plans will impose deductibles and/or copayments on Mail Order drugs in 2000. One plan - The Postmasters - does continue to waive copayments on Mail Orders. Those who expect to have large amounts of copayments in 2000 may want to consider changing to Postmasters this open season.

Dulles, VA: I was told by a local eye surgeon that George Washington University Health plan and Aetna will pay for laser eye surgery under their 'High Option' plans. I called and spoke with a customer service representative at Aetna that confirmed what the surgeon had said. I, however, cannot find this benefit in their brochures. Do you have any knowledge about this?

Bill Smith: While the plans list surgical benefits in their brochures, they do not list a particular kind of surgery (like laser eye surgery). You did the right thing by calling the plan; they are in the best position to tell you what is covered and what is not covered. Also, the surgeon's office should be in a good position to advise you about which FEHB Plans cover this surgery. The doctor's office has undoubtedly dealt with these plans in the past.

Maryland: I take a very expensive drug on a daily basis. My cost is $10 per month after insurance. The cost to the insurance company is $133 per month. Will my insurance company raise my prescription drug deductible and co-pay according to how much I cost them in 1999?

Bill Smith: Your cost as an individual is not considered in setting the deductibles and copayments. Rather, it is the group as a whole enrolled in your FEHB plan that determines the amount of the deductible and copays.

Fairfax, VA: Why is it that unlike most private sector companies, the federal government does not seem to offer 3 healthcare payment plans: one for single employees, one for married employees, and one for married employees with children. It seems crazy that my husband and I have to pay close to $200 a month for health insurance while families with as many as 6 kids pay the same amount. Is there any move in the works to make the programs more equitable?

Bill Smith: First and foremost, the FEHB plan is a group plan. To split the group into separate categories - like two persons, Medicare enrollees, non-smokers, healthy life styles, etc. - would destroy the group concept. Thoughout a career and into retirement, FEHB covers a variety of services - from birth of a child for younger enrollees to heart bypass surgery for older persons. One other point: The Office of Personnel Management costed - out a two person versus more than two person family enrollment. The premium would be the same for both.

Silver Spring, MD: I am currently employed by the Federal Government. We have an excellent Health Program, however, Dental Benefits still needs to be addressed. There are separate Dental Insurances available but only in Group Policies. I have not seen anything mentioned about this in the Washington Post Federal Column or in the NARFE magazine. Please address this issue since Dental Health is so much part of a person's general health, especially adult Dental care. Going to the Dentist to save your teeth should not be a question of having to first take out a second mortgage on your house.
Thank you for your time.

Bill Smith: Most FEHB fee-for-service plans (like BC/BS, GEHA) do not provide any substantial dental benefits. The reason is that improved dental benefits are costly - and would drive up the premiums. However, FEHB HMOs (like George Washington HMO) do, in fact, provide good dental benefits. Also, some of the federal plans do sell a separate dental supplement. See your plan brochure for details. Finally, our organization does sponsor a dental supplement for our members. Members can call 1-800-233-5764 for more information on NARFE's Dental Plan.

Potomac, Maryland: Hi Bill,

I'm a retired Federal worker and will soon be eligible for Medicare Part B. I'm currently covered by Blue Cross standard, which I intend to keep because all my doctors accept that plan. If I sign up for Medicare Part B, what additional health coverage over and above the Blue Cross do I get for the $45 I would have to pay monthly? Thanks . . .

Bill Smith: The real advantage of combining Medicare with BC/BS (or the other fee-for-service plans) is that the plans waive most of their and Medicare's deductibles, copayments and coinsurance amounts. The result is that you have little or no out-of-pocket expenses. We believe this fact alone is worth the $45.50 Part B Medicare premium.

One other point for your consideration. FEHB plans who have Medicare enrollees factor in an actuarial premium reduction (which recognizes that Medicare is primary). Therefore, when you enroll in Medicare, you help reduce the overall plan premium - for yourself and other plan enrollees.

Edgewater, MD: I have had Aetna US Healthcare for the last few years. There has not been options for high and standard in the past years that I have been a member. Now it appears that the plan will have high and standard options. I would like to know what Aetna will do if I do nothing this open season. Which option will they put me in? Which option has the same coverage as what I have had in the past? I am having a lot of trouble getting in touch with Aetna US Healthcare and I am going to be out of town during most of open season, including the day they plan to be on site at my office. Do you have any suggestions?

Bill Smith: The reason that Aetna US Healthcare has four options next year is that another plan (NYL Care Mid Atlantic) was taken over by Aetna US Healthcare and it has four options in 1999. If you have High Self or Family this year, you will be placed in High Self or Family in 2000. You can, however, change to Standard Self by notifying the Office of Personnel Management. Also, you should have received a notice from the Aetna plan about your options for next year.

Arlington, VA: Do you know if those that retire early with buyouts are eligible to keep their health benefits, presuming they pay for them? My agency says no. Thanks.

Bill Smith: First, those who retire and receive a buyout are eligible to keep their health plan coverage into retirement, if they had the coverage for at least five years before retiring. For those who receive a buyout but do not qualify for retirement, only, Department of Defense employees have the right to exercise the option to retain the health insurance.

Also, if you don't qualify for retirement, you can get an 18-month extension of your health insurance. This is called Temporary Continuation of Coverage. Ask your employing office for details.

Washington, DC: Does NARFE have a position on Sen. Bradley's proposal to offer federal employee health benefits to uninsured Americans? Is his plan directly tied to the real employee plan and would it have any effect on real employees?

Bill Smith: Former Senator Bradley has proposed that FEHBP would be available to Americans from age 19 to 64. According to the Bradley campaign's web site (http://www.billbradley.com), "a special needs pool will be established to assist those with greater than usual health care needs". We have asked Senator Bradley to provide an explanation of his proposed "special needs pool". And, while NARFE supports his goal of improving health care access for all Americans, we are concerned that current FEHBP plans and premiums would not be adequately protected for both federal and non-federal enrollees under the Bradley proposal.
It is important to remember that Senator Bradley's plan is just a proposal at this point. Rest assured that we are vigilant about any proposal that could harm FEHBP.

Alexandria VA: We are getting married in July, 2000. Is is possible and does it make tax-sense to change our withholding from single to married during the upcoming open season?

Bill Smith: There are no tax consequences of single versus married FEHB coverage. Changing from two Self-only coverages to one Family coverage has one potential advantage. That is, the Catastrophic Coverage (how much you pay out-of-pocket before the plan pays full benefits) is greater for two Self-only enrollees than one Family. For example, two BC/BS Standard Option Self-only enrollees using Preferred Providers would each have to have $2,000 out-of-pocket expenses - or $4,000 total - before the Catastrophic Protection starts. With a Family enrollment, only $2,000 total out-of-pocket for either or both enrollees has to be met. However, two Self-only enrollments usually cost less in premiums. For example, two Self-only BC/BS Standard enrollments cost $60.08 per pay period; one Family enrollment is $66.78; savings from two Self-only enrollments is $174.00 per year.

Bethesda, MD: I have been a member of GEHA for many years and they have been very good. Because of the great increase in cost for the coming year, I am considering switching to Blue Cross. What are the major differences between the two plans that I should know about?

Bill Smith: The main difference in GEHA and BC/BS is the premium amount. GEHA is $200.00 per month for family; BC/BS is $144.00 per month per family. Also, GEHA has reduced some other benefits. Your brochure will spell out what the reduction are. My view is that BC/BS is a better buy, both in terms of premium and benfits.

Wash., D.C.: My husband is employed by a pharmaceutical company. Would you suggest that I add him to my government health policy or should he continue to carry health insurance with him employer into retirement?

Bill Smith: If you husband's company coverage continues into retirement, you do not need to add him to your plan at this point. If he loses his coverage in the future, you can then add him by changing to family coverage - either at that point or in a future open season. Be sure you elect a survivor benefit for him when you retire. That is the only way he can keep your FEHB upon your death.

Silver Spring, Maryland: Please help me with the question of possible catastrophic long-term hospitilization. Which insurance available to Federal retirees would be best? High Option, Low Option? And, in conjunction with Medicare-Medicaid. Thank you.

Bill Smith: None of the Federal plans provide for long-term skilled care. In terms of long term hospitalization, most plans do cover hospital expenses. And, if you have Medicare Part A, you get benefits from that also. For long term skilled nursing care, you would either have to buy a policy which covers long term care or depend on Medicaid for coverage.

Chicago, Illinois: I am a Federal Employee who is planning on retiring in ten years or possibly sooner. I need to purchase Health Insurance to have the five year coverage before retirement. I am covered under my husband's health plan right now, so all I am looking for is a cheap insurance until retirement, since my husband's insurance will be the main insurance coverage. Any suggestions?

Bill Smith: You should enroll in an expensive plan like Mail Handlers Standard Option. This Open Season or in any future Open Season that will guarantee that you have the 5 years of coverage when you retire.

Silver Spring, MD: I am a Medicare recipient. Will Blue Cross pick up the 15% charge above the Medicare approved amount of a doctor who does not accept assignment? GEHA has been paying for this 15%. Will BC-BS do the same?

Bill Smith: The answer to your question depends on whether both Medicare and BC/BS cover the same services. BC/BS and GEHA normally pick up the difference if both cover that particular service.

Bill Smith: To clarify an earlier response about Mail Handlers enrollment. It should read Mail Handlers is an inexpensive plan, not expensive.

Fairfax, Va.: They kids are finally on their own and my wife and I -both feds- are planning to switch to self only plans. She has been covered under my family plan for the last 20 years. If we retire in four years, will the 5 year rule cause her to loose her health insurance in retirement or should be stay with the family plan?

Bill Smith: The period in which your wife was covered by your family enrollment counts toward her meeting the five year requirement. Either enrollee coverage or family coverage when both are Federal employees is counted toward the five years.

Annandale, VA: We have been enrolled in the same HMO for 10 years, but it has changed ownership - from HealthPlus to NYLCare to Aetna U.S. Healthcare. We have several children with specialized medical needs who routinely go to specialists within the HMO network. Now our primary care physician has informed us that he is considering dropping out of Aetna. His office also participates in Prudential's HMO, but I have just learned that they are also being bought out by Aetna. It seems that HMO choices are becoming more limited. Do we have to go to a Fee-for-service to stay with the same doctors we've been using for 10 years?

Bill Smith: As you point out, HMO enrollments are by nature more limiting in terms of selection of providers than are fee-for-service plans. While your plan is changing name, we would assume that your current providers will stay with the new plan. And you of course have the option to go to a fee-for-service plan. The choice is yours.

Southbury, CT: Do you recommend that younger retirees buy independent long-term health insurance policies? I've heard it's more of a bargain to buy in your 50s, rather than waiting until you're more likely to need it in your 70s or 80s.

Bill Smith: Most experts recommend purchase of long term care insurance when you are in your early 60s. As you noted, the younger you are when you buy, the less expensive it is. You may want to talk to some long term care agents and compare the rates at various age groups. One other point: There are several proposals pending in Congress to provide long term care insurance to Federal employees, retirees and spouses. The plans have not progressed very far at this point. I would advise anyone who is considering purchasing a long term care plan to not wait for the Federal proposal to be implemented. It is likely to be two years before anything happens.

Washington, DC: Glad you're here! My question is in regard to George Washington University Health Plan. I have had them for my insurance company for serveral years and have been very satisfied with them. However, I just found out that they have no gotten rid of their Standard option, and that if I want them to continue as my provider, I have to enroll under their "high" plan. How the heck can they say there is a High plan, if there is nothing to compare it to? It makes me angry because it seems they are being arrogant enough to say, we won't bother with a lower $$ choice for our consumers. What can you tell me about this? Thanks!

Bill Smith: Many plans - particularly HMOs - have only two options. In that case the High Option versus Standard Option has no meaning. They simply are setting up their plan as a one option provision. I think you will find that the benefits are not changing as a result of the change.

Falls Church, VA: As a retired, married federal employee, my wife and I both have Medicare -Parts A & B- amd GEHA. At ages 84 and 87 with various and sundry old-age afflictions, we have large drug requirements. How does GEHA compare with Blue Cross standard with respect to overall coverage. We have had several big-cost hospitalizations including heart by-pass and hip replacement. Would Postmasters be better?

Bill Smith: Generally speaking, we believe that BC/BS is a better buy for 2000 than GEHA. The reason is the BC/BS premium is about $50 less per month than GEHA. Also, both plans will require prescription co-payments in 2000 for Medicare enrollees. If you or your spouse have large prescription drug cost, you certainly would want to look at PostMasters.

Moderator: That's all the time we have. Our thanks to everyone, especially Bill Smith and NARFE.