Walton Francis was still preparing his annual guide to health insurance plans when The System got him on the phone last week. He said he had not finished reviewing the open-season options available to federal workers in the Washington area, but some things were already clear.

* "The trend of Blue Cross domination of this program is going to continue," he said. Indeed, Blue Cross says more than 54 percent of the 8 million people enrolled in the federal health insurance program have chosen one of its plans.

Why? "They kept their premium down at least as low as all the competition, and better than many," said Francis. The premium for the Blue Cross basic option is holding steady for 2005 -- how many private-sector plans can say that? -- and the premiums for the more generous standard coverage will rise by 3.7 percent for an individual, 4.6 percent for a family.

Product enhancements may be another reason.

Under the standard Blues plan, for example, up to 75 annual visits for physical, speech and occupational therapy will be available, subject to a $15 co-payment for each session. That's a better deal than the current terms, which require patients to pay in full for such sessions until their annual deductible is met.

In the basic Blues plan, lab work, X-rays and other tests will be fully covered in 2005. At present, a $20 co-payment is required for these services.

* "The HMOs are coming back," said Francis. "Traditionally . . . in this program, 40 percent of employees have chosen HMOs," but "in the last five years or so, there's been quite a fall-off . . . down into the thirties."

This year, "it's hard to say how people will choose, but it's certainly no slam dunk for Blue Cross to beat those HMOs. . . . In general, they are better deals."

* "CareFirst is back this year" among Washington area HMOs, said Francis. "Their premium went down significantly; they were very noncompetitive last year."

* As for the new high-deductible plans coupled with a health savings account (HSA), "I don't think they're going to set the world on fire, but there will be more people moving into those plans," said Francis. "And one of the interesting things about those plans is that they don't mostly attract the young and healthy. They attract, if anything, a disproportionate number of older and sicker, because they're good deals for those people, too -- and particularly because of the tax advantages to them."

Francis thinks those gains are small. "People have an exaggerated idea of how much they can build up these accounts," he said. "You're not going to get rich off them."

Francis's guide, due to appear in early November, is issued by the nonprofit Center for the Study of Services, which also publishes Washington Consumers' Checkbook magazine.

-- Tom Graham

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