A new study by the Federal Insurance Administration indicates that many government workers may be paying too much for health insurance coverage. Employes have only eight days left to decide what kind of health plan they want next year for themselves and their families.
Bureaucrats face a bewildering array of plans. More than 30 carriers are in the program, which covers 8 million people. Almost no guidance -- except from individual plans themselves -- is given to employes on insurance.
With the "open season" period for selecting insurance coverage ending Dec. 8, millions of employes are still trying to figure how to get the best coverage for the least money. The FIA, an arm of the Department of Housing and Urban Development, compared several major plans available to Washington area government workers.
The FIA study didn't look at all plans -- there are union plans, regional plans and special plans -- but it did deal with the three types of broad basic coverage, and major carriers offering them.
FIA's report indicates that many federal employes may be paying too much for insurance coverage they will probably never need, or may be helping to drive up health costs by subscribing to plans that require long hospital stays.
Decide for yourself which coverage is best for you. But look at the FIA report before you decide anything. First its comments on theHMOs:
Health Maintenance Organizations offer clinic-type services, plus house calls. The disadvantage of the HMO plans is that users must visit the clinic or hospitals designated unless they are out of town, or during emergencies. The three HMOs compared by the Federal Insurance Administration are the George Washington University Plan; Georgetown University plan and Group Health Association. Rates for high-option, self only coverage are almost identical running about $343 to $345 a year. GHA and Georgetown charge just over $900 for family high option coverage. GWU charges $827 a year. FIA says benefits from all three are "roughly equivalent"
They include hospital care with no dollar or day limit, unlimited outside care services (except GWU with a 365-day limit) and nearly identical accidential dental, maternity, drugs and mental treatment up to about 20 visits. GHA requires the highest contribution fom subscribers for drugs, according to the FIA analysis.
Blue Cross-Blue Shield, the largest insurance carrier in government, contracts with certain physicians and hospitals. The FIA says high option is similar to the HMOs listed earlier with these differences:
A hospital care limit of 365 days, which FIA says is a "minor" factor. For nonmember hospitals subscribers must pay 20 percent of the cost.
Medical and surgical, you pick the participating doctor but there is a $100 deductible for office and home call charges and the subscriber pays 20 percent of costs over that. Home health care is similar to the HMOs, but with a 90-day limit under the high option. Since there is no "extended care out of hospital coverage, FIA says, the patient must stay in hospital to get benefits. It says this is a "costly incentive in terms of inflation in next year's health costs."
The Blue Cross-Blue Shield high option self-only plan costs $279.76 a year. Family coverage is $624.78.
The other basic insurance coverage studied by FIA is the so-called indemnity plan. It chose to study Aetna, the second largest carrier, and the Government Employes Hospital Association Benefit Plan, called GEHA.
For hospital care in high option coverage, the subscriper pays 20 percent of everything, except room and board. The FIA analysis says Aetna pays 100 percent of the first $2,000 and GEHA pays 100 percent of all covered charges.
The FIA says both plans are "similar" to HMO coverage for home health care, and "unfortunately" similar to Blue Cross-Blue Shield for extended care. That means you stay in hospital to get benefits.
High option Aetna and GEHA limits out of pocket payments to $2,000 a family, the HUD agency said. Costs of the plan are $198.38 and $327.60 for self and family high option under Aetna, and $130 and $224.38 for high option self only, and family coverage under GEHA.
The price differences are enormous, as are benefits and coverage. FIA says an employe can "save" $700 a year -- the difference between GEHA and Georgetown coverage by gambling the family will not be hit by a catastrophic-type loss. It recommends that employes shopping look at plans in this order: 1 -- GEHA, which has the "lowest cost, high-option plan available." 2 -- Aetna's low option ($63.18 and $149.50). 3 -- Group Health Association's low option.
"If you must have the most complete protection of a Health Maintenance Organization," the FIA suggests, "use George Washington University and save the $80 unless it is so inconvenient when compared to Georgetown or GHA."