FEHB Plan Coverage Features

Using the Guide's cost comparisons, you should first select several plans for which your costs are likely to be relatively low. The second step in selecting a plan is to focus on any special needs or circumstances that the cost tables do not fully reflect. The third step is to consider how important it is to you to retain a particular doctor(s) and, if necessary, to find out whether your doctor belongs to particular plans. The best way to do this is simply to call the doctor's office and ask. You can also go to the plan's website, or get a provider list at a health fair, but those provider lists are sometimes out of date. You can reverse the order of these steps, but it never makes sense to pay an extra $1,000 in premium if the most you will spend on a particular physician or service is a few hundred dollars. You should save the "for sure" premium cost and if necessary pay for a particular visit directly, without using your insurance.

Even if you know you are going to use a particular service, you can enroll in a plan that costs less overall but doesn't necessary have a particularly good benefit in that area. Use the savings to establish a Flexible Spending Account and focus that spending on that special need. Flexible Spending Accounts give employees (but not retirees) a way to reduce foreseeable costs substantially. If you anticipate, for example, having substantial dental or speech therapy expenses even after your coverage by health or dental insurance, you can set aside up to $2,600 in a health care FSA account ($5,200 for a couple) and that income will not be subject of Federal and State income taxes, or to Social Security taxes. For most, this has the effect of reducing the amount you actually pay by about one third. You estimate your likely spending and set up this account during the same Open Season used for selecting health plans. An FSA is perfect way to get about a one-third discount on a benefit for which your plan restricts coverage. FSA accounts are no longer "use or lose" and you can carry over up to $500 into the next year without penalty.

Still, it is best to choose the low-cost plan that best covers an expense you can predict. Our Guide focuses on benefit categories that vary widely across plans, such as non-network psychiatric care.

We have worded the comparison headings to allow standard entries, such as "Yes," "Some," or "No." A "Yes" always means broader coverage and a "No" always means narrower coverage. However, even though a number of plans are rated "Yes," this does not mean that the benefits are identical. You need to compare brochures.

Very importantly, if you know that you will need some specific and expensive type of care, whether or not it is in our Guide, and whether or not the brochure seems clear, it is always a sensible strategy to talk to at least one potential provider and ask the simple question "Which plans pay best for the care I need?" You can also talk to a plan representative, but the information you get is not always reliable and carries no guarantee. The actual providers (or their office staff) know which plans pay best in the real world. Explore especially carefully if the service is near some boundary of coverage. For example, some hospitals provide regular hospital care, skilled nursing care, and custodial care in the same facility. You need to be sure that whichever level of service you get will be billed and paid under a category paid by your plan.



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