New lawmakers are afforded best U.S. health plan

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One of the first, and most important things new members of Congress were told at their welcome-to-Washington orientation is that they are now eligible for what is considered the best health plan in the nation.

That would be the Federal Employees Health Benefits Program.

The FEHBP is a rarity today. A cradle-to-grave collection of health plans that can't drop you or turn you down because of your age, retirement status, health, bad habits or pre-existing medical conditions. And the government pays a little more than 70 cents of each premium dollar.

Within the next several weeks all members of the giant federal family -- current and former feds and current and former spouses -- must make one of those potentially life-altering decisions: Which health plan will they choose for the year 2007.

The open season in which they pick their new health plan began Nov. 13 and ends Dec. 11. Experts say that everybody should shop around during the open season and that roughly 20 of every 100 persons in the FEHBP would be better off picking a plan other than the one they are in now.

But if the past is any guide, then only about six of every 100 persons will actually make a switch to a better, maybe lower-cost plan.

There is no magic bullet, no pill, no formula that will help individuals pick the best health plan for their situation. But there are some guidelines to consider. Among them:

• Do you want a fee-for-service plan that lets you pick your doctor, your hospital and help determine the course of your medical treatment. If so, the premiums are usually somewhat higher as are deductibles and co-payments.

• Do you want the convenience of a health maintenance organization that may have a one-stop facility, a more limited choice of doctors who charge minimal co-payments and, through managed care, stresses preventive medicine.

• Your choice will be easier if you check with your primary or favorite doctor to see whether he or she participates in the HMO or is part of the preferred-provider network of the fee-for-service plan.