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Making the Best of It

By Mike Causey
Washington Post Staff Writer
Wednesday, October 22, 1997; Page B02

Looking for a low-cost, covers-most-everything health plan?

If so, you can either:

A) Move immediately to Norway. It has a dandy health plan. But no dental coverage, except for children and people completing their military service -- which is mandatory.

There are no premiums, as such. But that is a tad misleading. Premiums (and other state- supported services) are included in the tax bill. Norwegians pay rates that are so high they would give most Americans an immediate heart attack.


B) Make the best of your existing options here in the United States. If you are a federal worker or retiree, those options are good. Most have the choice of 40 plans and options. And they can change plans (or options) at least once a year. And get full coverage immediately regardless of age or preexisting conditions. Retirees pay the same premiums as young, healthy workers in the same plans. Lifetime coverage includes surviving spouses (sometimes ex-spouses), grandchildren in some cases and disabled adult children.

The government pays about 72 cents of every premium dollar. That means premiums paid by feds and retirees in fee-for-service plans next year will range from $14 every two weeks for low-cost single coverage, or about $37 for family coverage, to $136 every two weeks for high-cost family coverage. Most health maintenance organization premiums are much lower, but the choice is wide.

Premiums next year are increasing an average of 8.5 percent.

The government has done a good job holding down premiums. Insurance plans continue efforts to cut costs. One way is setting up their own preferred provider organizations, or contracting out to give subscribers a PPO option. Doctors and hospitals agree to discounts in order to be included in the PPO network. People who stay in the network may pay only a small ($10 to $20 a visit) co-payment. Those who go outside the network pay more. Their plan may cover only a portion (say, 80 percent) of the established usual and customary fee.

Today, the House civil service subcommittee (of the Government Reform and Oversight Committee) is set to approve a catchall bill covering the federal program. Big-money outfits, from the health plans to the American Medical Association, have an interest. Each side says the other's position would hurt policyholders and raise premiums.

Among other things, the bill would make it easier for the Office of Personnel Management to kick out doctors and providers who engage in professional or financial misconduct. It also would let retirees from the Federal Deposit Insurance Corp., which has its own health plan, into the federal employees health program. The most controversial proposal in the bill would require health plans to provide extensive written disclosure of the methods used to secure favorable rates.

Opponents say that provision could raise premiums by increasing administrative costs and making it harder, in some instances, to negotiate discounts.

Backers of the disclosure requirement say it would protect providers, and policyholders, from entering into contracts for rates they do not fully understand.

One thing is certain. Health insurance isn't going to get any cheaper. And the federal health program, which covers 10 million people, including nearly half the folks in this area, helps drive private rates. That's why it is important, to lots of people and to the country's economy, that the good guys prevail.

The trick is deciding which team that is.

Copyright 1997 The Washington Post Co.

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