Federal Diary Live
With Stephen Barr
Washington Post Staff Writer
Wednesday, Nov. 27, 2002; Noon ET
Can't figure out which federal employee health plan is best for you? Thinking about switching plans? Are some plans better for retirees than employees?
Walton Francis, the principal author of Checkbook's Guide to Health Plans for Federal Employees, joins The Post's Stephen Barr, who writes the Federal Diary column, to take your questions and comments about the 2003 open season for the Federal Employees Health Benefits Program.
Francis is a self-employed economist and policy analyst, with expertise in the evaluation of public programs. He has written on a wide range of subjects, including program evaluation, statistical analysis, managed health care and retirement benefits.
Francis developed regulatory, budgetary and legislative reforms for many programs and policies while working at the Office of Management and Budget and at the Health and Human Services Department. He has published articles and testified several times before Congress on FEHBP and Medicare. He holds master's degrees from Yale and Harvard universities.
Checkbook's Guide has been published in book form and sold to employee, retirees and federal personnel offices for 23 years. An online version of the Guide debuted for the 2001 open season and is provided free to employees at more than a dozen federal agencies. Checkbook provides a specially tailored version of the online guide for free to retirees. The Guide is sponsored by the nonprofit Washington Consumers' Checkbook magazine.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Stephen Barr: Thanks to all of you joining us today, especially our guest, Walton Francis, a top-notch expert on the federal employee health insurance program. The government, as employer, is offering 188 health care options to government employees and retirees this year. So, Walt, let's start with a basic question: What are the most important things that people should keep in mind as they sift through their options? Again, Walt, thanks for spending time with us today.
Walton Francis: Even if you are satisfied with your current plan, be sure to read the Change page in the brochure to make sure there is no bad news. Consider whether your health situation and any changing needs suggest changing plans. Do not focus on either premium or benefit changes alone, but consider both together. If you have a doctor you really want to keep, ask his office what plan(s) he will be preferred in next year. Finally, consider whether some other plan may be better next year even if you are satisfied--there are bargains out there!
Washington, D.C.: Do you have a suggestion for a couple (65+) with Medicare (part A & B), and Tricare for Life. Would a standard option for Mail Handlers and/or Blue Cross work?
Thanks and Happy Thanksgiving!
Walton Francis: People with both Medicare and Tricare for Life don't need a third insurance plan! You can suspend your FEHBP enrollment without penalty and rejoin later if you need to. In the meantime, take the premium savings!
Davie, Fla: APWU is offering a new consumer-driven option. What is your opinion of this?
Walton Francis: The new APWU Consumer-driven plan is not only a real innovation, but one of our top ranked plans in almost all situations. It even works well with Medicare, though that is not its intended group. By all means consider it. But study it carefully and understand that there are some risks in using it.
Springfield, Va.: My husband and I are planning a month-long trip to Australia next year. Which plan do you recommend for coverage while out of the country?
Walton Francis: All of the plans will cover you well for an emergency abroad, even the HMOs. So I wouldn't switch plans just because I am taking a trip. For continuing care over a period of time, GEHA Standard, Blue Cross Standard, and Foreign Service (for those eligible) are very good.
Washington, D.C.: Senior Moment: What benefits a Federal retiree over 65 to pay both a Part B premium to Medicare and another "supplemental" premium to a Federal health plan? Both my 69-year-old husband and I are in good health, rarely reaching our yearly deductibles, so why spend $2400 or so to a Federal health plan? I've been trying for years to make sense of this, so thanks for your help.
Walton Francis: You've got it just backwards, but the question is key. The real issue is why do you need Medicare Part B. All the Federal plans give better coverage by far than Medicare (e.g., they cover drugs), so if you don't want to pay two premiums drop Part B and save, next year, $1400. Of course, you do lose some wraparound coverage and can't rejoin Medicare without a penalty, but over time you will save. Never, ever drop FEHBP coverage because you cannot rejoin and it is far superior.
Washington, D.C.: Hi Mr. Francis, thank you for all of your work in this area. My question is about coverage for regular psychotherapy treatment. My psychiatrist does not participate in any health plans, and I'm trying to determine which plans reimburse the most for non-network counseling.
It's difficult to ascertain just how much each plan reimburses; a brochure reports that I'm responsible for "30 percent of our allowance plus costs exceeding our allowance," but no one will tell me how much that allowance actually is. Would it vary, by plan, for the same doctor's treatment, and any advice on how to find out before enrolling? Thanks.
Walton Francis: Several of the fee for service plans will cover you for around $1500 in out of network psychotherapy costs with the provider of your choice. But they are likely to pay only about half the cost of each visit. The allowance varies from zip code to zip code, but is likely to be somewhere around two-thirds of your doctor's fee. So you will pay about half. But there is no way to find out in advance.
Ashburn, Va.: Until recently, my children and I were covered under FEHBP through my late husband's survivor benefits. When I re-married this past summer, I lost my benefits but my children, ages 9 and 11, continue to be covered by the program. I wanted to use the checkbook program as offered by OPM for retirees to decide whether to change the children's health insurance during open season, but I can no longer access the OPM retirees site. I presume this is because I, myself, am no longer a beneficiary. How can I access the comparison program on behalf of my children?
Walton Francis: You can subscribe for individual access to the Web comparison Guide, or the printed book (take your pick) from www.guidetohealthplans.org. You can actually access the retiree site at www.retireehealthplans.org but this wouldn't be right for your kids.
Sacramento, Calif.: Mr. Francis, I have purchased your book for years, and find it an invaluable tool. Thank you for the work you have put into developing it. I notice that a couple of the PPO plans that rate highly, such as Blue Cross Basic and GEHA Standard use a formulary for the prescription drug benefit. I believe in both cases that a drug not in the formulary is covered at 50 percent of the cost (if purchased at a member pharmacy). Obviously, if you are already on a non formulary prescription, this has to factor into your decision as to which plan to select. My question is, is there any way to for a layman to determine how likely it will be for a physician to prescribe a non formulary drug (In other words, how extensive are the formularies)? How big a factor should this be in our plan selection? Thank you.
Walton Francis: First, most plans put their formularies online, so it is easy to check the status of the drugs you use. If you have our Guide, we provide a direct link, or just go to the Plan's Web site. The difficulties involved are described reasonably well in the Plan brochures drug sections. In almost all cases you can readily get approval if the doctor says medically necessary, but you will nonetheless pay a higher copayment.
Richland, Wash.: I'm considering switching from an HMO to APWU's new Consumer-Driven Option. I'm married with two small children. We're all pretty healthy. Do you have any thoughts or advice on this new plan? Thanks.
Walton Francis: A particular strength of this plan is that it lets you build up a "Personal Savings Account" of up to $6000 for a family if you have several good years in a row. But you do face considerable coinsurance (15 percent) if someone spends even a few days in the hospital before your balance builds up. The Plan has a great feature in paying 100 percent of annual physicals and immunizations if you use preferred provides.
Virginia: I am a retired federal employee and am part of the Federal Employees Health Benefits Program. Stephen's column of Nov. 25, 2002, cited certain premium changes in the HMOs but said little about CareFirstBlueChoice of Virginia. I joined this group last year when George Washington's HMO went out of business and have been happy with their range of services and doctors. This open season I was shocked by the new costs for a single individual -- my monthly premium will go from $69.l0 to $111.39 and the government's share from $155.45 to $242.58 and the co-pays to doctors will double from $10 to $20 per visit. I do believe CareFirst has now become the most expensive HMO in the FEHB Program. Considering that they want to provide their executives with multi-million dollar bonus' for the merger with Wellpoint, I think their rate structure is well above the government average. But CareFirst is now only one of two HMO's available in my part of Virginia so I am not able to consider a change except to Kaiser. What a frustrating situation. Your view, Mr. Francis?
Walton Francis: Yes, it is very frustrating. And CareFirst's premium is very high for an HMO. But check again. I think that anywhere you are eligible for Kaiser you can join MD IPA (which is very reasonably priced) and the Aetna options.
New York, N.Y.: Would you identify the top three FEHB PPO providers in terms of overall employee satisfaction?
Walton Francis: We have found through member surveys that almost all enrollees in these plans are highly satisfied with their service. But some plans score higher than others on particular aspects. This is too complicated for an easy summary but among the higher scorers are APWU, NALC, and GEHA. MD IPA does best among the local HMOs. You can see the detailed survey results on the OPM Web site or in our Guide. We also have an alternative measure in the Guide, using disputed claims information to see how plans vary in this dimension of service. NALC and APWU score well, Blue Cross is near the middle.
Oak Hill, Va.: If you were looking for the best deal on dental coverage, how would you evaluate the plans? Which do you think offer the best value for dental coverage?
Walton Francis: Locally, the best dental coverage is found in Kaiser and MD IPA HMOs. APWU Consumer-driven gives you 100 percent coverage up to $400 for an individual, but only by using up that much of your "Personal Care Account". All three of the above plans have relatively low premiums and we rate as good buys.
Washington, D.C.: Two quick questions: Has the Checkbook's Guide done a recent review of available federal health plans? What is the best way to obtain this information -- i.e., is the guide available at bookstores or should I subscribe to a website for further information? Second, are there any other recommended websites or other info sources that provide consumer ratings and qualitative opinions on health plans? For example, I am more interested in whether a patient is actually ever able to obtain care at a reasonably located urgent care center, than whether the option of receiving care at the urgent care center is technically available on a particular health plan. Thanks for appearing on this chat -- it's very helpful!
Walton Francis: Yes, we have a current and highly detailed set of comparisons in our 2003 Guide. You should be able to buy a paper copy at all area bookstores (they usually put it in the magazine section), or you can order by phone from 202-347-7283. Easiest to buy and use is to get it online at www.guidetohealthplans.org. It is free to all Federal retirees at www.retireehealthplans.org. We do include ratings of user satisfaction for urgent care, but I am not sure they really deal with your question. We don't rate individual providers in the Guide, though Checkbook does have separately available books rating physicians and hospitals (but not urgent care centers).
Columbia, Md.: I am a retired Federal employee who has just become eligible for Medicare. I have Parts A and B. For the past several years, my husband and I have had GEHA High option and been very pleased. He has since passed away and I am looking at coverage for myself only. I have had no serious health problems, but I do take three prescription drugs for arthritis. I am very tempted by the low monthly cost of GEHA Standard but would like to know if I am overlooking any negatives by switching to the Standard option.
Walton Francis: We rate GEHA Standard option as a great buy for retirees with Medicare. On average, it will save you several hundred dollars compared to Blue Cross Standard, because its premium is so much lower. But if your drug bills (retail prices) run well over $1000 a year this advantage dissipates, and for people in the $2000 and higher range Blue Cross is generally a better deal. You didn't ask this, but I want to mention that there are many good arthritis drugs, some very low priced, that are equally effective for most people. They vary mainly in side effects.
Alexandria, Va.: Can you give a a good pro & con comparison between Mail Handlers Standard and Blue/Cross Basic? I really don't quite understand the BC Basic plan.
Walton Francis: Both are "bargain" plans, though the Mail Handlers premium has crept up in recent years and we don't rate it as highly overall. Mail Handlers Standard covers hospitals 100 percent, but has terrible drug coverage (you pay the first $600). Blue Cross Basic has good drug coverage and a moderate admission charge for hospitals. But you MUST use a preferred provider in Basic. Blue Cross signs up most providers, but in this respect it operates almost like an HMO. Overall, we rate Basic considerably higher, and for most as an even better plan than Blue Cross Standard.
Miami, Fla.: I am currently enrolled in GEHA standard but I'm thinking of switching. I am married with two teen-agers and the family has no major medical problems. Your recommendation?
Walton Francis: GEHA Standard is one of our top ranked plans. Sounds like you should fine tune your choice based on particular benefit features most important to you, provider participation, the "hassle" factor, or other plan details. I wouldn't leave GEHA Standard unless you find something clearly better for you. But take a look at Blue Cross Basic and Standard, and APWU Consumer-driven, or almost any HMO.
Washington, D.C.: Mr. Francis, we've had three years of double-digit premium increases. What steps should the government take to increase its leverage and rein in these increases?
Walton Francis: This program reflects the market for health care in the United States. Every employer faces repeated double-digit increases. OPM works very hard to keep premiums down; one of the methods is to increase copayments, which moves money from one pocket to another but also encourages frugal health care use. This system is so much better than other government run health care plans that I hope they don't try to use more leverage and mess it up.
Springfield, Va.: On your website for retirees, you provide a service that orders the plans by lowest estimated cost to you. Does this cost include both the premiums and the out-of-pocket expenses during the year?
Walton Francis: Yes it does. The essence of our comparison method is to take into account all of the money you are likely to spend, including not only the "for sure" premium expense but also copayments and gaps for uncovered services.
Burke, Va.: We have a child with special needs who really needs to go to Children's Hospital and we have Blue Cross. Seems to be the best coverage based on my research, esp. for durable medical equipment. I've written to both Children's & Blue Cross re our situation. What will bring them back to the negotiating table? We need to make a decision before Dec. 9--what if they resolve things after that?
Walton Francis: I'm not sure if the contract dispute applies to all Blue Cross plans, including the Standard option, or just the CareFirst HMO. If anyone knows the answer, let us know. If you are sure you need to use Children's, I would switch to another plan. Most have this hospital as a preferred provider. Unfortunately, you have to decide by December 9 and don't get to switch again for another year.
Washington, D.C.: I'm a 54 yr. old Federal worker (female) and my husband (62 yrs. old) works for the D.C. government. We have no children. We're both lucky to be healthy, although I had corrective surgery for basal cell skin cancer earlier this year (recurrences possible). I was happy with my Blue Cross/Blue Shield coverage for the surgery, but now my primary care doctor has dropped out of the plan, and his regular check-up costs are around $1,200/yr. out-of-pocket. (We'd prefer not to switch doctors.) Should we stay with our current plan, or is there another plan that would be better for us?
Walton Francis: Your doctor sounds awfully pricey for regular checkups. Regardless, the first thing I would do in your situation is ask his office manager what plans he will be preferred in next year. There are probably several. One of those will probably be a good deal. If he isn't affiliated with any reasonably priced plans, I would seriously consider switching physicians.
McLean, Va.: We currently have BC/BS and wonder if we should change from standard to basic. We have 2 young children and family is relatively healthy. Would like to get your opinion. Thanks in advance.
Walton Francis: We rate Blue Cross Basic as likely to save a family of four about $300 a year compared to Standard (premium difference is bigger and there is no deductible in Basic but Standard has slightly better benefits overall). The only real issue is that you MUST use BC preferred providers. You should anyway, to save money, of course. Only you can decide whether the better flexibility is worth it.
Chester, Md.: My wife and I are both over 65 and have Medicare Parts A & B. For years I have been enrolled in the Mail Handler's Benefit Plan -- high option. My drug bill is approximately $6,000 annually, average doctor and hospital use. Should I continue where I am? Switch to Low Option or switch to GEHA (high or low) or some other plan? Thank you!
Walton Francis: You should have switched years ago. Drug benefits are the weakest area in both Mail Handlers plans and the high option is very pricey in premiums. You should give first preference to Blue Cross Standard with drug bills that high. Run, don't walk, to switch.
Arlington, Va.: I am in the early stages of pregnancy and considered high risk. I'm not in BC/BS, but our OB is a "participating" provider with BC/BS, although not in the PPO. Your advice?
Walton Francis: You really want to use a preferred provider in any plan. Unless your obstetrician will agree to accept the Blue Cross rate of payment (and it is probably under his or her usual charge), you need to switch plans (to one where he is preferred) or switch doctors.
San Francisco, Calif.: If a Federal employee works beyond age 65 does he have to enroll in Medicare or can he continue with his current health plan? If he does not enroll in Medicare at 65, will he be able to enroll at a later date without penalty and can he continue his current health plan in retirement (assuming he pays the premium)?
Walton Francis: Anyone who works past 65 can delay enrolling in Medicare without penalty. Yes, you can continue your current plan (or any other) in retirement, provided that you are continuously enrolled in some FEHBP plan or plans for five years before retirement.
Fairfax, Va.: Would it make sense for a husband and wife who both work for the federal government, and who have adult children no longer covered by FEHBP, to obtain two separate Self-Only coverages rather than stick with one Self and Family coverage? We are confused on this point because the cost of two Self-Only coverages in the GEHA High Option Plan is virtually the same as the cost of Self and Family coverage. But the cost of two Self-Only coverages in the GEHA Standard Option Plan is significantly less than the cost of Self and Family coverage. Also, if we were to change from our current GEHA High Option Self and Family to separate Self-Only coverages in GEHA Standard Option, would my wife still meet the five-year pre-retirement coverage test if she retired next year (i.e., does her 30-year inclusion under my Self and Family coverage count even if she retires with her own Self-Only coverage that whe would have for less than a year before she retires)? Thanks for your help!
Walton Francis: Yes, a couple like yours can sign up for two self only enrollments. But you face a big risk: two catastrophic ceilings instead of one. If you are both in an expensive accident you will rue the day you switched from family. Whichever way you go is okay for retirement. You each have to be continuously enrolled, but either coverage under a family enrollment or self only counts.
Washington, D.C.: My son has autism -- what type of insurance would be best for his treatment? Thanks.
Walton Francis: None of these plans set their benefits by disease or condition, except for a few exception areas like dental. What you should do is consider the precise treatments you son needs (e.g., certain drugs) and see if plans differ on these particular drugs through their formularies. Also, you may want to use a particular physician, and the plan or plans he or she is "preferred" in would be a starting point.
Atlanta, Ga.: The Blue Cross Blue Shield representative told me that if you were taking three or more prescriptions every month that the Blue Cross Blue Shield standard option was better for you than the BC/BS basic. Do you agree? Thanks.
Walton Francis: I half agree. For generic drugs, and relatively inexpensive brand name drugs, Blue Cross Basic is great. Only for really expensive brand name drugs (like a $100 a month retail price) does Standard really beat it. If you have two or three of those expensive prescriptions, then Standard is better than Basic.
Bettendorf, Iowa: I was well satisfied with my coverage under Mail Handlers, Standard Option, before I turned 65 years old. What advantage is there for me to enroll in Medicare B and pay that extra premium every month?
Walton Francis: It is a close question, in general, whether it is worth paying $700 a year, per person, for Part B. It won't be worth it if you stay in Mail Handlers, because the two plans are both strong for hospital and doctors, and both weak for drugs. Consider a much lower priced plan with at least decent drug coverage, like GEHA Standard. Then decide whether Part B is worth it.
Lorton, Va.: I am a retiree, with a wife covered by an HMO in FEHBP. Is there any benefit at all to enrolling in Medicare Part B?
Walton Francis: If you are both enrolled in an HMO, and plan to stay there indefinitely, you do not need Part B. You will save a lot of money every year by not paying the B premium, and lose almost nothing in benefits. If you have a more complicated arrangement (I can't tell from your question as worded), one or both of you may need to take Part B.
Burke, Va.: Re the Blue Cross/Children's Hospital situation: yes, both the HMO and PPO plan holders are affected. HMO holders can no longer go to Children's effective Jan. 1, 2003. PPO holders can continue to go to Children's, but pay "out-of-network" costs which include a higher percent of allowable expenses, plus the difference between the actual bill and the allowable amount. In our case, that could be many thousands of dollars (our son has had 14 surgeries in his nine years). His durable medical equipment expenses are exorbitant and there aren't many providers who are even in network, so we dig deep to cover those costs as well. As far as going to other hospitals, only Children's offers the multidisciplinary program which our son's diagnosis requires, to manage the complexities of his condition. So for us, and many other special needs families, it is a very disturbing (and potentially costly) situation. Thanks for your advice.
Walton Francis: Okay, seems like all of you who rely on Children's should depart from the Blue Cross plans. But don't worry, several other plans have premiums and coverage as good if not better than Blue Cross. Good luck! That is what Open Season is all about.
Centreville, Va.: You mentioned risks with the APWU plan; can you tell me what some of them are? Thanks.
Walton Francis: The main risk with this plan is that its cost-sharing includes a $600 deductible (after you use the $1000 Personal Allowance) and then 15 percent cost sharing until you hit the catastrophic limit. These are not terrible features, but obviously expose you to more cost sharing than plans with small deductibles and 100 percent coverage of hospital expenses. We estimate that on average, taking into account both low cost years and high cost years, this plan belongs on anyone's short list to consider. But be sure to read the brochure section on Consumer-driven very carefully before you join. The plan rewards best those who are frugal shoppers for health care. Good luck!
Stephen Barr: Walton Francis, thanks so much for joining us today and fielding questions. I'm sorry to say we've run out of time and could not get to all the questions, but I'm certain this transcript will be valuable reading for employees and retirees. Again, thanks to you and to all of you who joined us today. We will be back at noon next Wednesday. Have a terrific Thanksgiving!
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