Jimmy Choo at Payless Shoes?

Tuesday - 11/27/2012, 2:00am EST

In a perfect work world, our employer would offer us a designer health plan. Like so:

  • Young, healthy people could go with a low-premium health maintenance organization (HMO) that should cover most of them nicely. Couples with kids, or planning them, could seek out plans that offer the best and lowest- cost maternity benefits.

  • As we age and the kids start breaking bones, we would upgrade to a family plan that limited our out-of-pocket costs while providing the best protection.

  • Between ages and stages, we might want a plan with super dental benefits for our aging choppers and the kids' retainers.

  • As we get older and medical bills increase, we would need yet another plan with, among other things, good prescription drug benefits. Walton Francis, editor of Consumers' Checkbook Guide to Federal Health Plans estimates that feds under 55 with "average" medical costs in 2013 will shell out $1,800 in premiums and out-of-pocket costs if they have self-only coverage in Blue Cross- Blue Shield's basic plan. But that total cost (premiums and out-of-pocket) will rise to $3,980 for the average person over age 55, and to $6,540 for the average retiree without Medicare Part B. Big difference.

    So what we are looking at, in the perfect health plan world, is a plan designed around us. And one that would change as we got larger, older, no longer had dependent children and as our aches, pains and medical bills grew.

    The solution is a self-designed plan, but at group rates. In group plans, everybody pays the same premiums and gets the same coverage in the same plans. Older people (and childless couples) help subsidize people with kids. Younger, healthier people help subsidize older workers, etc. That's a group plan. Hence group rates like the Federal Employee Health Benefits Program (FEHBP).

    It covers more than 8 million people from current and retired members of Congress to the youngest civil servant to the oldest federal retiree and their spouses and dependents - a lot of people. And the government pays about 70 percent of the premium tab. And that percentage stays the same even as premiums go up.

    Many people inside the government think the FEHBP — with 20 to 30-plus choices — think it could be a lot better. If it was designed by them and for them. Many people outside of government would kill to get into the FEHBP, even if it meant getting a government job or marrying a very ugly or unpleasant federal worker.

    Yesterday's column was about one of the most common complaints feds (mostly couples without kids) have about the FEHBP — the fact that each plan has only two options: self-only or family. And the fact that the government defines a family as two or more people with self-only as one person. The couples argue that there should be another choice, a self-plus plan that would cover two people but at lower premiums than the family plan.

    The idea is not new. Studies have shown that it would shatter the group plan concept because, if it was allowed, it would soon be filled by older, less healthy couples who would cost the group more money.

    Nick S., a retired fed with a big family, seems to get it. He commented:

    "...I can understand why someone without kids would want another option under FEHB rather than self-only and self and family. But there is a fairness/insurance consideration here. At one time my self and family option covered me, my wife, and our seven children. Now that it's just me and my wife, and we're in our 70s, our health care expenses are about the same as when we had all our kids home. So I think it's only fair that I continue to pay for self and family, even though seven fewer people are insured."
    Bottom line is that people should concentrate on hunting for the best health plan in the remaining weeks of the hunting season. The FEHBP, if feds are lucky and budget-cutters don't come after it, isn't going to change. That's why people need to concentrate on the choices they have and shop around. Tomorrow's Your Turn radio show features Walton Francis as our guest.

    Listen if you can (1500 AM or online), and if you have questions email them to me at mcausey@federalnewsradio.com or call in during the show at (202) 465-3080. The show will be archived here.