CAUSEY: Vital decision now on '10 health plan

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By Mike Causey

One of the most important decisions you will make this year, maybe in your entire life, involves the federal health plan you pick in 2010. That's true whether you are getting married (or divorced), looking for maternity benefits or applying for Medicare.

If you or a family member is diagnosed with a major illness next year or is involved in a serious accident, having the proper health plan could literally save your assets. Any of those things, no matter how good your diet, how careful you are or what shape you are in, could happen anytime.

Federal workers, retirees and others eligible for the Federal Employee Health Benefits Program (FEHBP) have until Dec. 14 to pick their 2010 plan. If past is prologue, only about six of every 100 people will change. That's a big mistake most years — and an even bigger and more costly one this time around. Why?

Blue Cross-Blue Shield's very, very popular standard option plan is raising premiums about 12 percent for family coverage and 15 percent for self-only coverage next year.

That's a problem because 45 percent of all enrollees have standard option. For retirees, about 90 percent are covered by the popular Blues plan. What to do?

A little homework, please. Compare the premiums and out-of-pocket costs you are likely to have next year against the outlay for similar plans.

If you have a fee-for-service (national) plan, consider a health maintenance organization. HMOs are local (except for out-of-area emergencies). Also look at HD (high deductible) and CD (consumer-driven) plans that are rated highly and allow you to build up a savings account in the process.

How do you do this homework? Unless you are very good with numbers and have a lot of time and not much of an outside social life, let somebody else do it for you. Like us.

How did we get so smart? We talked to the people at Washington Consumers' Checkbook and got their Guide to Health Plans for Federal Employees. While it's sold in bookstores, you may get the information free from your federal agency.

Many, from the Defense Intelligence Agency to the Departments of Treasury, Energy and Transportation, have purchased an online version of the guide. It permits users (for free) to punch in their numbers, age, medical wants and needs, and price range and get a list of "best buys" for various groups.

Walton Francis, author of the guide (his 31st year) considers coverage, premiums and out-of-pocket costs not covered by insurance to come up with his best buys. The guide is broken down by age (older people use more health care) and family status: single, married, married with children, married with lots of children and retired with and without Medicare.

Here's what it looks like:

• A single person younger than 55 looking for an HMO should check out Kaiser-Standard, Kaiser High Option, MD-IPA, CareFirst Blue Cross, Aetna basic and Coventry high option. Total costs to you next year, if you have an "average" medical-year will range from a low of $1,330 to a high of $1,860. For a family of three, the cost to you (premium and out of pocket) will be about three times higher.

• A single person looking for a national plan (using preferred providers) should consider such best buys as Blue Cross basic (not the standard option), Foreign Service, GEHA (Government Employees Health Association) standard and APWU (American Postal Workers Union) high option. The total costs to you for an "average" medical year in 2010 will range from $1,740 to $1,920. The cost to you for a family of three would, naturally, be much higher. Be sure your doctor will be participating in the plan next year.

• For a single retiree, the best-buy ratings are similar, whether the retiree has Medicare Parts A and B or only Part A. The rank order in total cost to you would range from $3,100 for Kaiser standard to about $3,740 for Aetna Open Access Basic. Within that range, slightly higher than Kaiser but less than Aetna, consider MD IPA, Kaiser high option, Coventry standard option, Aetna Open Access Basic, and CareFirst BlueChoice. Again, premiums would be much higher for a married couple.

• Enroll in an FEHBP plan — pick any one with low premiums — even if you use your spouse's private-sector health plan. That's because your spouse's coverage could disappear or your spouse could go away. In order to keep the federal program for life in retirement, you must be enrolled in one of its plans for the five years before retirement.

• Look at the catastrophic limit. That's the amount you will have to pay out of pocket before insurance takes over. Catastrophic coverage is the reason you buy insurance. A worst-case coat of armor. Mr. Francis says the coverage in the federal plans ranges from good to wonderful.

• If you are a federal couple, one working and the other retired, make sure the working fed (not the retiree) signs up and pays the family premium. You'll get the same benefits but save a lot of money. Reason: Working feds can pay their premiums with pre-tax dollars, saving from $300 to $800 per year in federal taxes. That so-called premium conversion perk is not available once you are retired.

This is one open season you probably cannot afford to sit out.

• Mike Causey's Federal Report runs Mondays. Contact him at mcausey@federalnewsradio.com or 202/895-5132.