For federal employees and retirees, trying to sort out premium increases, higher co-pays and deductibles often ends up as a frustrating open-season chore.
Premiums in the Federal Employees Health Benefits Program will rise an average of 11.1 percent next year -- the third consecutive year that premiums have jumped more than 10 percent.
Employees and retirees thinking of changing plans must decide by Dec. 9, when the 2003 open season ends. As in past years, individuals and families can save money by shopping around.
You should not pick a plan based only on its premium, but it's important to remember that premium increases vary more than the 11.1 percent average suggests.
For example, the premium for a family under the Blue Cross and Blue Shield basic option, which requires an enrollee to stay within a network to receive benefits, goes up 8.6 percent in January. In contrast, the family premium for the Mail Handlers high option, a traditional fee-for-service plan, increases by 17.5 percent.
Among area HMOs, the premium increases vary significantly. Kaiser Permanente's family coverage rises by 10.9 percent, while the family rate at MD-IPA increases 15.4 percent.
It's even more difficult to assess and compare co-pays, deductibles and benefits when employees and retirees can select their coverage from among 188 health plans.
As Walton Francis, an expert on the federal health program, said: "Which is worse, a $300 hospital deductible or a $30 co-payment for each prescription? It all depends on what health expenses you will have next year. And even if you are sure about a few items, you can't predict all."
Francis, the principal author of Checkbook's Guide to Health Plans for Federal Employees, points out that co-pays and deductibles help control costs in the federal program.
"Plans that charge co-payments not only keep their premiums lower, but also encourage prudent purchasing decisions by enrollees," Francis said. "Plans that find the better balance over time attract more enrollees and reduce overall insurance costs."
Still, Francis added, a number of plans had little or no increase in co-payments for 2003, including two of the most popular plans -- Government Employees Hospital Association standard option and Blue Cross standard option. In GEHA's case, there was no increase in the premium for the standard option.
Each year, the Checkbook Guide, sponsored by the nonprofit Washington Consumers' Checkbook magazine, rates each plan on total expenses, including premiums and out-of-pocket costs. The ratings, where appropriate, reflect the use of pretax dollars by employees to pay health insurance premiums.
For a family of four, the Checkbook Guide shows, local HMOs would cost hundreds of dollars less than the lowest-cost nationwide plans.
For HMOs, Checkbook estimates the total cost of Kaiser at $2,190 annually, MD-IPA at $2,300 and Aetna standard option at $2,710.
Among nationwide plans, Checkbook shows that three plans are good buys, with two others not far behind. Checkbook calculates the total cost of Blue Cross basic at $3,080 annually, Blue Cross standard at $3,410 and the American Postal Workers Union consumer-driven option at $3,470. Close behind are GEHA standard, at a total cost of $3,630 annually, and the National Association of Letter Carriers plan at $3,660.
Employees at more than a dozen agencies can go online to the guide to identify the best buys for their families. Employees without free access can log into the guide (www.guidetohealthplans.org) for $8.95.
Thirteen agencies have signed up to provide employees with PlanSmartChoice, which also compares FEHBP plans. Employees can reach PlanSmartChoice through www.employeeexpress.gov and agency Web sites.
The Office of Personnel Management, which oversees the health program, is providing retirees with free access to Checkbook and PlanSmartChoice. The retiree online page (www.opm.gov/retire/fehb) links to the two consumer guides. Checkbook also offers a specially tailored version for free to government retirees (www.retireehealthplans.org).
Federal Diary Live Can't figure out which federal employee health plan is best for you? Thinking about switching plans?
Walton Francis, Checkbook's expert on FEHBP, will take questions from federal employees and retirees about the 2003 enrollment season at noon Wednesday at www.washingtonpost.com. Please join us.
Stephen Barr's e-mail address is firstname.lastname@example.org.