Tips for choosing the right health plan during Open Season

Friday - 11/18/2011, 1:59pm EST

Expert Panel on Federal Open Season

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By Michael O'Connell
Web Editor
Federal News Radio

It's time for federal workers to do their homework. They have until Dec. 12 to educate themselves about their health care options and then decide if it's time to make a change.

For advice, insight and analysis, the Federal Drive with Tom Temin and Amy Morris turned to three experts in the Open Season arena — Colleen Murphy, executive for PlanSmartChoice, an ADP product; Walton Francis, editor of the Checkbook Guide to Health Plans for Federal Employees; and Federal News Radio's Senior Correspondent Mike Causey.

"This is probably the dullest Open Season we've had maybe in 30 years," Causey said. "And that is a good thing because what it means is that premiums in most cases are not going up very much and some plans are dropping them slightly." He added that changes in benefits have been minimal, so people can just concentrate on what's the best plan for them.

What most feds don't know that they should know, according to Francis, is what the alternatives are to their current plans. If customers don't take the time to investigate, they may be missing out on thousands of dollars in savings by choosing another plan.

Federal Drive hosted a Nov. 18 panel on open season with, from left, host Tom Temin; Colleen Murphy, president and CEO of Asparity Decision Solutions; host Amy Morris; Federal News Radio's Senior Correspondent Mike Causey and Walton Francis, editor of the Checkbook Guide to Health Plans for Federal Employees. (Photo by Jamie Blanco).

"It's very important to remember that you can join any plan without any regard to pre-existing conditions," he said. "There are no constraints. ... So you have a free choice in the D.C. area, for everybody, of about 24 plans and a few extra plans for those who happen to be in the intelligence or foreign affairs communities."

Although premiums, on average, increased about 3 percent, in reality, that shouldn't be much of a difference, Murphy said. "It's about what your total health care costs are, and those are driven by your out-of-pocket expenses as well as your annual premium."

Across all of the plans, the annual health care cost for a single person in the Washington area ranges from $2,000 to $5,000, compared to an employee with a family, whose yearly costs range from $3,000 to $9,000, depending on the plan he or she chooses.

"Obviously, the companies aren't in it for fun or pleasure, they're in it to make money," Francis said. "But the beauty of it is that it's a competitive program."

The competitiveness helps to keep the costs for customers low. If a company tries to maximize its profits, their premiums increase and they lose customers.

"They're trying to maximize benefits, service and keeping premiums down all at the same time," he said. "Each company strikes a slightly different balance, which is greatly to the advantage of the customers, because federal employees get to pick and choose the plan that fits them best."

Motivation is key

For some people, Francis said, choosing a health care plan is akin to having a root canal. It's important but unpleasant.

"Can you imagine looking at the 100-page health-plan brochure?" he asked. "Your eyes glaze over before you've opened the cover. ... Part of it is that it's work of an uninteresting kind. But, if you think about it, your family's health is really not that uninteresting. It's really important."

He and Murphy recommend using online resources to help speed up the process.

"On average, Plan Smart Choice users spend about 15 minutes on our site selecting a health plan," Murphy said. "We've had more that 20,000 federal employees use the tools just this week."

What's important, she added, is making the decision making process as interactive and as personalized as possible, to help individuals choose the best plan.

In this down economy, with many employees working paycheck-to-paycheck and with a federal pay freeze in effect, it makes good financial sense to take the time to choose the best plan.

"Just because you're not getting a regular cost-of-living increase doesn't mean you can't make a lot more money next year simply by choosing a less expensive health plan," Francis said. "When people go on the Checkbooks tool, spend five or 10 minutes, we right away show them here's how much you can save by being in Plan A versus Plan B in dollar terms."

Look at the details

According to Francis, the things that present the biggest problems for people choosing health care options are those that are unknown.

"Everyone probably knows what pills they're taking next year for whatever their ordinary ailment is," he said. "But you don't know if you're going to get cancer or have a heart attack or a stroke or any of 101 terrible things that happen to you or any member of your family."

Employees need to look at the details of each plan to find out what it actually covers and what its catastrophic limit is.

Murphy listed three things for feds to consider when choosing the right plan:

  1. What is your family going to need in terms of medical services for the year? Look at what medical services were used in the previous year and anticipate which ones will continue into the coming year.

  2. What is your relationship with your physician or your provider? Is your physician covered under the plan, or will you have to pay out-of-pocket? That doesn't mean you should ditch a plan because you'll have to pay out-of-the-pocket. The plan may have other strengths that balance out that extra expense.

  3. Review the satisfaction scores of others who have used the plan. The Office of Personnel Management offers FEHB members results of an annual survey online.

The average federal worker has been in the government for 17.3 years.

"If you went into a health plan back in the day, maybe it was a fee for service like Blue Cross or Samba, or an HMO like Aetna. They have changed dramatically over the years, and they've gotten more alike," Causey said.

All the more reason to make sure your plan suits you and your family best.

Federal News Radio will continue to provide more information on Open Season through various interviews and reports in the coming month. Visit our Open Season page for more.

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