Ironically, as health maintenance organizations become more popular with federal workers and retirees, the number of HMOs they have to choose from is shrinking.

Federal employees and retired federal employees in Delaware, Utah, South Dakota and New Hampshire have only one HMO option in each state. Only two HMOs participate in the federal health insurance program in Alabama, and federal workers and retirees in South Carolina have only three HMOs to choose from.

Federal workers and retirees can join any of the seven nationwide fee-for-service plans. But if they like an HMO, the pickings are slim and getting slimmer.

About 40 percent of federal workers and about 13 percent of retirees belong to a local HMO.

Nearly 100 HMOs (most of them outside the Washington-Baltimore area) have left the program since 1998 or will leave by the end of the year. Some merged with other HMOs.

Even with the shrinking number of choices available, federal workers and retirees still have more health insurance options than most private-sector employees. A typical private-sector company offers workers a choice of four or five plans. In the Washington-Baltimore area, federal workers can choose from the seven national fee-for-service plans (such as GEHA and Blue Cross-Blue Shield) and seven local HMOs.

The open season, when workers and retirees can change plans, runs from Nov. 8 through Dec. 13.

HMOs have lower premiums than most fee-for-service plans. They also have very low co-payments and minimal paperwork, and they offer some of the best dental benefits and preventive medicine programs in the federal program. For many federal workers and retirees, the out-of-pocket cost of an HMO is minimal.

The drawbacks to HMOs, for many people, are the limited choices of doctors and medical facilities and the fact that--except in emergencies--HMOs don't cover people outside their areas.

Federal employees and retirees in the same federal health plans pay the same premiums, regardless of age, health or preexisting medical conditions. Nobody can be turned down by any of the plans for any reason.

Federal workers pay premiums biweekly (26 times a year). Retirees pay the same premiums, but their payments are made monthly (12 times a year).

Previous Federal Diary columns have listed next year's biweekly premiums for federal workers. During the open season, there will be a series of columns listing "best buys" for singles, couples, big families, retirees with and without Medicare and for people with special medical programs or medical needs (such as good dental coverage).

Here are next year's monthly HMO premiums for retirees in the Washington area:

* Aetna U.S. Healthcare: High option, self only, $63.63, up $13.16 from this year. High option, family, $167.55, up $40.58. Standard option, self only, $40.46, up $4.79. Standard option, family, $94.90, up $11.08.

* CapitalCare: Self only, $56.03, down 80 cents. Family, $167.85, down $70.31.

* Free State Health Plan: Self only, $99.82, up $48.10. Family, $235.78, up $49.23.

* George Washington University Health Plan: Self only, $52.79, down $20.96. Family, $136.30, down $19.03.

* Kaiser Permanente: Self only, $50.92, up $3.62. Family, $125.88, up $6.13.

* MD-IPA: Self only, $56.66, up $6.20. Family, $162.82, up $25.91.

* Prudential HealthCare: Self only, $72.06, up $22.09. Family, $153.29, up $43.29.

Richmond vs. Washington Reader D.W. Watson says: "I've enjoyed your columns about locality pay differentials. I found Sunday's column--about the likely locality pay raises for different U.S. cities--especially useful. That leads me to a question. I may be taking a job in Richmond. It would be at the same grade level. Can you give me a for-instance example of what that differential is between Washington and Richmond. I am a Grade 11, step 3. Thanks."

A GS 11, step 3, in the Washington-Baltimore area is paid $43,428 this year. For the Richmond job--same grade and step--the salary would be $42,921. (Those figures do not take into account next year's raises, which have not been finalized.) With trade-offs, such as less traffic and lower living costs, you might be better off, even with a slightly lighter paycheck.

Japan Fellowships Federal workers with a career interest in the U.S.-Japanese relationship can apply for a two-year Mansfield Fellowship from the Mansfield Center for Pacific Affairs. The popular program provides a year of study in this country in Japanese culture, politics and language, followed by a one-year assignment in a Japanese government office in Japan. The program is named for longtime Senate majority leader Mike Mansfield (D-Mont.), who later was U.S. ambassador to Japan.

There will be an information session on the fellowship program Thursday afternoon at the center's downtown Washington office. For reservations or information on the program, send an e-mail to Jennifer Washeliski at: jeniwash@mcpa.org.

Mike Causey's e-mail address is causeym@washpost.com

Tuesday, Nov. 2, 1999