The federal health program has insiders and outsiders. Insiders think their premiums are too high. Outsiders willingly pay much more for coverage under the program.
As politicians propose opening up the federal health program, the issue of who pays what could become a major issue. Example:
Active-duty and retired federal workers in a self-only plan will pay from $548 (Mail Handlers standard option) to $3,100 (Postmasters high option) in premiums next year. Blue Cross standard option, the most popular plan, will cost single feds and retirees $780 next year.
But thanks to the average 72 percent contribution Uncle Sam makes to retiree and employee premiums, the cost of coverage to insiders seems like a bargain to outsiders. Outsiders pay the full premium.
Thousands of people, including many who never worked for the government, pay much more to belong to the federal health program. Many are the ex-spouses of workers or retirees. Some are temporary feds. Others are children who, upon reaching age 22, no longer qualify (because they are not disabled) for coverage under a family plan. All those outsiders have one thing in common: They pay three to four times as much for the same coverage as regular federal workers and retirees.
Even paying much more in premiums, the outsiders receive coverage that is usually less costly than they could get elsewhere. The coverage is generally better, too. Like the insiders, they can keep their coverage past age 65 (when most private plans stop covering retirees). And they can't be turned down because of age or health.
Next year, the least-expensive health plan in the federal program for people who must pay the full premium is Kaiser Permanente, a health maintenance organization. Someone who does not qualify for a government contribution will pay $2,440 for self-only coverage. For a federal worker or retiree, the same coverage will cost $611.
A federal worker or retiree enrolling in the Blue Cross standard-option family plan next year will pay $1,736 in premiums. Anyone who does not receive a subsidy will pay $6,310 for the same coverage.
Here's a look at premiums next year for several fee-for-service plans and HMOs, showing the cost of self-only coverage to insiders (federal workers and retirees) and to outsiders (people who have to pay the full premium):
Aetna US Healthcare, standard option, $486 for an insider, $1,940 for an outsider; George Washington HMO, $630 for an insider, $2,530 for an outsider; M.D. IPA, $680 for an insider, $2,720 for an outsider; and GEHA, $1,190 for an insider, $3,240 for an outsider.
Checkbook's Guide to Year 2000 Health Insurance Plans for Federal Employees advises feds and retirees to consider total costs (not just premiums) in picking a plan. The idea is not to skimp on premiums and lose out on coverage.
But for people who pay the full freight, the guide says things are different. "Because the full premiums are so costly and benefits vary much less than premiums, we rate plans with the lowest premium as the best for persons who pay full premiums," the guide says. "The Mail Handlers standard option rates highest as a full-premium, fee-for-service plan open to all single persons and families."
Many HMOs, the guide says, offer even lower costs and have much better prescription drug benefits.
At 9 a.m. tomorrow on WUST radio (1120 AM), benefits expert John Elliott will talk about picking a health plan and about federal benefits in general.
At 10 a.m. tomorrow on WUST, the Office of Personnel Management's Christina Gonzales Vay and Ivonne Camille Cunarro will talk about the government's new initiative to hire people with disabilities.
Mike Causey's e-mail address is firstname.lastname@example.org