Just how healthy is your year 2000 federal health plan?

Take two aspirin and call us about this time next December.

What's at issue is the annual migration pattern of federal workers and retirees who--each year in November and December--get the chance to move from one insurance company to another. Their action can make or break a health plan.

The federal program covers 9 million people. Those in the same plans get the same benefits and pay the same premiums. Nobody can be rejected because of health or preexisting conditions, or kicked out at age 65.

But in reality, the giant program is hundreds of big and small plans with no control over who joins--or leaves--them. During the open season (it ended Dec. 13), anyone can switch plans. Many are expected to because premiums are going up an average of 9.3 percent next year, with one popular plan's rates up 26 percent.

Normally few people switch during open season. But this one may be the exception to that rule.

The size of the program and the age of its participants (most private plans cut off retirees at age 65) make individual plans vulnerable to adverse selection. That's when a plan has too few healthy premium-payers and too many heavier users of medical and prescription benefits. More than 100 plans have left the federal program in the past couple of years although nobody--worker or retiree--has lost coverage.

Most of the dearly departed plans were HMOs. But half a dozen union-sponsored plans plus the once top-rated BACE plan (for congressional employees) also have left the federal program. Aetna dropped its popular fee-for-service plan but retains an HMO.

Most of the plans left because their membership got too small--or too sick. But adverse selection can be a two-way street. Example:

GEHA this year is the third most popular plan. Experts give it high marks. But its big premium jump next year may have triggered an exodus.

If GEHA and other plans lose lots of members, will that hurt or help?

We should know about this time next year. Common sense says losing customers is bad. But it depends on who those customers are. Lose the "right" ones, the expensive ones, and you have a prescription for success. Results of the just-completed open season won't be available until early next year. But here's where the health plans stack up--in terms of people who are covered--this year:

Blue Cross is the largest. It has 1,905,243 total enrollments. Most people in Blue Cross are in its standard option.

Mail Handlers this year has 433,524 enrolled. It has the lowest premiums of any fee-for-service plan, and its premiums also are lower than most HMOs'. The Mail Handlers plan charges people who aren't members of its union an associate member fee of $42 a year. It is a popular plan for people who use a private-sector spouse's health plan but want to satisfy the five-year coverage rule so they and their spouse can switch to the federal program, which is superior in retirement.

GEHA is No. 3 this year with 249,520.

NALC health plan had 101,948 enrollees this year.

APWU health plan had 88,966.

The Rural Letter Carriers plan this year had 41,935.

Kaiser Mid-Atlantic had 72,535; M.D. IPA had 21,241; and the George Washington University plan had just over 17,000 enrolled.

SAMBA (the plan for federal law enforcement personnel) had 16,272; Postmasters, 12,731; Aetna U.S. Healthcare (an HMO), 10,034; and the Alliance plan had 4,524.

In addition to higher premiums, the prescription drug costs of most health plans are changing. In most cases, retirees who once got prescription drugs free by mail will now have to make a co-payment for those drugs. Their costs next year, depending on their plan, will range from $2 to $30 for a 90-day supply. Although that's a bargain--considering some of the drugs cost hundreds of dollars--it represents a major cost to individuals who are taking many drugs.

Best/Worst Dressed

The polls are closed on our unscientific, but fun, venture into the world of federal fashion. In last Monday's column, we published the comments of a current fed and a visiting federal contractor on the state of dress in various agencies. That triggered a ton of e-mail on the subject with comments from workers and nominations for the best- and worst-dressed agencies.

The results are coming up this week. If you voted, thanks. But please, no more e-mail on that subject--we got the message!

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

Sunday, Dec. 19, 1999