It is one thing to read that health insurance premiums are going up an "average" of 9.3 percent next year. It is another to see what that "average" means in dollars and cents in the premiums for your particular health plan.
Beginning in January, new premiums--some higher, some lower--go into effect for the roughly 300 plans in the Federal Employees Health Benefits Program. Typically, federal workers and retirees have about 20 plans to choose from, including nationwide fee-for-service plans and local health maintenance organizations.
Federal employees and retirees, regardless of age and health, pay the same premiums and get the same benefits as long as they are enrolled in the same plan. They can switch plans during the November-December open enrollment period. The government pays about 72 percent of the total premium.
By shopping carefully, people can achieve big savings in premiums next year, especially those who shift from a fee-for-service plan to an HMO. (But they should think twice about switching to an HMO if they have doubts about managed care.)
Premiums, of course, are only part of the story. Deductibles and out-of-pocket costs, which are rare in HMOs, are also important. Workers and retirees have plenty of time, and they will get lots of "advice" before and during the open season.
Members of Congress from the Washington area will sponsor health care fairs throughout the area that are open to the public. The Federal Diary will publish the dates and locations of the fairs. Rates and other information about various health plans will appear elsewhere, including The Washington Post's Health section and the Federal Times Newspaper. The Office of Personnel Management's Web site lists next year's premiums.
During the open season, as per standard practice, the Federal Diary will run a series of "best buys" as rated by experts Walton Francis, of the Washington Consumers' Checkbook magazine, and Bill Smith, of the National Association of Retired Federal Employees. They will offer advice on which plans people in particular groups (singles, large and small families, retirees with and without Medicare and people with special medical needs) should check out.
In the end, you must decide. Those who don't change plans during the open season will remain in their current plans. For many people, that is okay. But it always pays to shop. And not panic.
When word of the 9.3 percent "average" increase came out, some people wondered whether they could afford coverage next year. After all, federal workers are due a 4.8 percent pay raise, and retirees are looking at a cost-of-living adjustment in the neighborhood of 2.3 percent.
Actually, the pay raise and the COLA-- though smaller percentages than the average premium increase--will more than offset premium increases for most workers and retirees. But large premium increases in some plans make it important to shop wisely and change plans if necessary.
Some people may have another motive for switching. They may want to follow a favorite doctor from one preferred-provider plan into another. Doctors change plans, too.
Whatever you do, if you're a federal worker, do not drop coverage.
To carry federal health insurance, for life, into retirement, you must be enrolled in one of the plans (any one will do) for the five years preceding retirement. You can't, for example, be enrolled under a husband or wife's private-sector plan and then, just before retirement, switch into the federal program and take it with you into retirement. Many private-sector plans drop retirees or their spouses, or they raise retirees' premiums and cut benefits. Retirement is when the federal program shines.
But shop around.
Tomorrow's Federal Diary will show next year's premiums for fee-for-service plans, which now cover about 60 percent of enrollees. Blue Cross-Blue Shield, a fee-for-service plan, is also the largest single plan in the federal program.
Other Federal Diaries will list premiums for area HMOs and premiums for plans that cover specific groups of workers (such as Foreign Service or Secret Service employees).
The Federal Diary also will list premiums for postal workers. Under their union contract, they pay less for health insurance, because the Postal Service picks up a larger share of the premium. That is not true, however, of postal retirees.
There also will be columns listing premiums for retirees. Although retirees pay the same annual premium for health insurance as active-duty federal workers, their payments are withheld from their monthly annuity checks. Workers' deductions are made from their biweekly checks.
Mike Causey's e-mail address is firstname.lastname@example.org
Wednesday, Sept. 29, 1999