Despite the fact that many health maintenance organizations offer low premiums, require minimal paperwork and have low co-payments, many federal workers--and most retirees--continue to shy away from them.
The debate on managed care has refocused the limelight (not always kindly, or accurately) on HMOs.
But fear of HMOs could change next year as policyholders, worried about the average 9.3 percent increase in premiums, take another look at premiums charged by some HMOs.
About 30 percent of enrollees in the federal employees health benefits program are in a managed-care HMO. In the federal health program, HMOs have traditionally offered the best dental coverage (with some paying for up to half the cost of many procedures). They are also rated highly for maternity benefits, well-baby care and preventive maintenance.
But most HMOs restrict the choice of doctors and facilities (more than fee-for-service plans) and their coverage is local. HMOs will cover emergencies out of the area, but otherwise require policyholders to adhere to local HMO rules, visit selected local doctors and hospitals and practice managed care.
The average 9.3 percent federal health premium increase in January has unnerved many feds--and especially retirees. But that's an average. Some plans will go up, some down.
Federal workers in this area can choose from at least 14 plans. They include seven fee-for-service plans, plus seven (in the Washington metro area) HMOs.
They also have the option to switch plans--without any restrictions--during the open enrollment period. It begins Nov. 8 and runs through Dec. 13.
Federal workers and retirees have a wider choice of health plans than most private-sector workers. That gives them more leeway when premiums go up. They can simply switch to a less costly (if premiums are the issue) plan.
Under the federal program, nobody can be denied coverage because of age or existing medical conditions. Retirees (unlike many private-sector health plans) and their survivors pay the same premiums, and get the same coverage, as younger, healthier workers in the same plans. The government pays an "average" of 72 percent of the premium. In some instances, workers and retirees can cover grandchildren. Former spouses can also get coverage under the federal health program--via court order--but they must pay the full premium. Even so, paying the group rate full premium is often less than the cost than if they sought nongroup coverage for the same kind of plan.
On Sept. 30, the Federal Diary ran the new, year 2000 employee premiums for fee-for-service plans. Federal workers pay premiums biweekly. Retirees pay monthly. But both pay the same annual premium.
Today's Federal Diary spotlights the employee biweekly premium cost for HMOs in this area. Future Federal Diary columns will list best buys--as rated by experts--for singles, families, retirees with and without Medicare and for people with special health problems.
Here are the new (2000) HMO biweekly premiums for nonpostal federal workers:
Aetna US Healthcare. For high option, self-only coverage the employee will pay $29.37 per pay period, an increase of $6.08. For high-option family coverage the premium will be $77.33, an increase of $18.73. Self-only standard option, $18.67, an increase of $2.21. Family standard option, $48.80, an increase of $5.11.
CapitalCare. Self only, $25.86, a decrease of 37 cents. Family coverage, $77.47, down $32.45.
Free State Health Plan. Self only, $46.07, an increase of $22.20. Family, $108.82, an increase of $22.72.
George Washington University Health Plan. Self only, $24.36, down $9.68. Family plan, $62.91, down $8.78.
Kaiser Permanente. Self only, $23.50, an increase of $1.67. Family, $58.10, an increase of $2.83.
MD-IPA. Self only, $26.15, an increase of $2.86. Family, $75.15, an increase of $11.96.
Prudential Health Care HMO. Self only, $33.26, an increase of $10.20. Family coverage, $70.75, an increase of $19.98.
Health Benefits Guide The National Association of Retired Federal Employees is offering a free Health Benefits Guide to active and retired federal workers. To get it, call 800-838-3821 or send your name and address with a request to: firstname.lastname@example.org.
Mike Causey's e-mail address is email@example.com
Tuesday, Oct. 12, 1999