Evaluating FEHB Health Plans
Evaluate and Compare Federal Health Insurance Plans
As you research, evaluate and compare federal health insurance plans, it is important to look for the best value. Don’t get caught up on the plan name (e.g., Standard Option, Consumer Option, Value Plan, etc.). Remember, value is a balance of many factors, such as provider choice, coverage, cost and what works best for you.
Here are a few important things to consider as you compare federal health plans; be it MHBP’s plans or overall FEHB plan comparison.
Compare Federal Health Plans: Provider Choice
- Determine if you need a local federal health plan or a plan with national coverage. If you travel frequently or have children away in college, you may want to compare national federal health plans.
- Confirm your provider’s participation in the network by calling the health plan and the provider before you enroll.
- Make sure the provider types and specialists you need are included in the network (e.g., dermatologist, oncologist, ophthalmologist, gynecologist, etc.).
- Review any requirements the plan may have for getting care through a specialist.
Tip: Choose providers that participate in your health plan’s network. You will maximize your federal health insurance benefits and save money.
Compare Federal Health Plans: Coverage
- Read the health plan information and benefit descriptions (official plan brochure) to learn what medical expenses and services are covered by the plans you are considering.
- Check that the federal health plan you are considering covers any services you expect you will need (e.g., family planning, chiropractic care, overseas coverage).
- Consider your utilization of services (i.e., how often you expect to use certain services). Review any limitations or exclusions for certain services that you may require at some point in your life.
- Carefully review the drug formulary of each federal health plan you are evaluating to determine if the medications you take are covered and how much they will cost you.
Tip: Make a list of the medical services you will need and call each federal health plan you are considering to confirm what is covered. It is important to select a plan with benefits that best meet your needs.
Compare Federal Health Plans: Cost
As you compare federal health insurance plans and attempt to predict your annual health care costs, you want to look at five key elements:
- Premium—The cost of the federal health insurance—this amount is deducted from your biweekly paycheck. Premiums can vary across the benefit plans offered to you.
- Deductible—The amount you must pay for health care before the federal health plan you’re considering begins to pay. Deductibles typically apply on a per-calendar-year basis. There may be separate deductibles for different types of services. Deductibles can change from year to year.
- Copayment—A fixed dollar amount that you pay as your share of the cost of medical services you receive (e.g., $20 for a doctor’s visit).
- Coinsurance—A percentage of the cost you pay as your share of the medical services you receive (e.g., 20% of the cost of a lab test).
- Catastrophic Protection Limit—The maximum amount for certain covered charges you have to pay out of your pocket during the year. Setting a maximum amount protects you. Separate limits are usually applied on a per-person and per-family basis.
Tip: As you compare federal health insurance costs, keep in mind the services you use most often and services that you need or want. This will give you a good indication of your potential out-of-pocket costs.
Compare Federal Health Plans: Service
You should contact the federal health insurance plan you are leaning towards before you become a member, which will allow you to experience their customer service first-hand. When you call, you can assess how easy it is to reach a real person and get answers to your questions. If your co-workers are enrolled in the health plan you are considering, ask them to rate their experience.
Tip: Good service is essential to your benefits working for you. Choose a federal health insurance plan that has knowledgeable service representatives who are able to answer your questions.
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