If you are suffering from health plan decision fatigue, welcome to the club.
Workers and retirees have until Monday to pick a health plan for next year. Some plans are reducing benefits. Some are raising premiums. Some a lot.
Most Washington-Baltimore area federal workers and retirees can join any of six fee-for-service (pick your own doctor) plans or seven health maintenance organizations.
Some plans, like SAMBA, Association, Foreign Service and Rural Carrier are restricted to employees and retirees of certain agencies. If you don't recognize the names, you probably can't join.
All of the plans are good. But some cost too much. Annual premiums for self-only coverage next year will range from $550 for the Mail Handlers standard option and $780 for the Blue Cross standard option to $1,720 for the Blue Cross high option and $3,176 for the Postmasters high option.
HMOs provide the best dental benefits, covering one-half to two-thirds of many procedures. But for people seeking comprehensive dental coverage, none of the federal plans--like most of their private-sector counterparts--has a good enough dental benefit to make that the sole reason for joining.
The low-premium Mail Handlers plan is very good. But it has a weak prescription drug benefit because of its high deductible for drugs. Many people join Mail Handlers (even if they are covered under a spouse's private-sector health plan) simply to maintain eligibility for coverage under the federal health program when they retire. In most cases, to be covered in retirement, feds must have been enrolled in one of the federal health plans (any one) for the five years immediately before retiring.
The Postmasters plan has a high premium, but for people with Medicare coverage who take lots of prescription drugs, it is worth checking out. The plan's prescription coverage for people in Medicare is the best among the seven fee-for-service plans available to retirees. Next year, most other health plans will impose or raise prescription co-payments, even for prescription drugs by mail. People who order brand names (as opposed to generics) will pay even more.
GEHA, one of the more popular plans, will raise premiums about 25 percent next year. Locally, NYLCare, an HMO, is leaving the federal program and is being replaced by Aetna US Healthcare. Active-duty workers in NYLCare have to select another plan to avoid losing coverage altogether. Retirees in NYLCare will be moved automatically into the Aetna plan unless they choose another.
Checkbook's Guide to Year 2000 Health Plans for Federal Employees rates plans according to total average cost. That is the amount someone will likely pay in premiums (and members fees, if any) and out-of-pocket costs not covered by a plan. For instance, here is how the Checkbook guide, using that total-cost-to-you system, ranks plans for self-only coverage (in descending order, with the lowest-cost plans first):
* HMOs: Kaiser Permanente, George Washington, M.D. IPA, Aetna standard option, Capital Care, Aetna high option, Prudential and Free State.
* Fee-for-service plans: Blue Cross standard, Association, Foreign Service, Mail Handlers standard, Postmasters standard, APWU, GEHA, SAMBA, NALC, Mail Handlers high option, Alliance, Blue Cross high option and Postmasters high option.
Insurance experts recommend you use your fee-for-service plan's preferred-provider option. PPOs encourage members to go to doctors and hospitals in their networks. If you go out of network, you nearly always will pay a lot more.
Retirees with Medicare are fortunate. Bill Smith, of the Alexandria-based National Association of Retired Federal Employees, says they have almost total coverage, except for co-payments (as noted above) for mail order prescription drugs.
As a rule, retirees without Medicare can weigh the options using the same criteria as active-duty workers. (Retirees without Medicare looking for self-only coverage, for instance, might do well to consider the Checkbook rankings above.) For Medicare-covered retirees with relatively large prescription costs, Postmasters may be the best buy.
Federal Pay Tables
Here's what the Office of Personnel Management says about year 2000 pay tables: "Pay tables reflecting the 4.8 percent overall average pay adjustment . . . are not yet available. Conference report language . . . anticipates that the president will allocate that amount between an across-the-board increase and a locality pay raise. Until that determination is made . . . OPM will not be in a position to prepare or release pay tables."
The January cost-of-living adjustment for retirees breaks down this way: 2.4 percent for benefits under the Civil Service Retirement System and 2 percent for benefits under the Federal Employees Retirement System.
Mike Causey's e-mail address is firstname.lastname@example.org
Wednesday, Dec. 8, 1999