What Medical Expenses Your FEHB Plan Covers

Our cost comparisons cover medical, hospital, dental, and prescription drug costs. They show how you are likely to fare under every national and local plan available to Federal employees. We show how each plan handles various levels of financial risk for you.

Our cost ratings tell you how much you are likely to pay for premiums and out-of-pocket (unreimbursed) medical expenses added together. The tables assume that your bills might be for almost any type or size of expense, including:

  • Hospital room and board for surgical or medical care for any illness;
  • Other types of hospital services (operating room, anesthesia);
  • Surgery, in or out of a hospital;
  • Diagnostic tests, X-rays, and lab tests in or out of a hospital;
  • Doctor visits in or out of a hospital when you are ill;
  • Mental health treatment, outpatient and inpatient;
  • Mammograms, Pap smears, and routine immunizations;
  • Maternity, even if you are in a self-only plan;
  • Emergency care in or out of a hospital;
  • Prescription drugs, including insulin and syringes for diabetics;
  • Nursing care after an illness;
  • Chemotherapy and radiation therapy;
  • Physical and rehabilitation therapy;
  • Cosmetic ("plastic") surgery or oral surgery-only after an accident;
  • Dental care;
  • Preventive care including physical examinations and vaccines; and
  • All of these expenses are covered even if you have a preexisting condition or are hospitalized on the date when your enrollment begins.

All plans cover routine exams without deductibles or copayments. Only some plans cover dental care. And most plans expose you to significant out-of-pocket costs, such as not including all prescription drugs in their formularies. Even among plans that cover all services generously, however, there are always some limitations, such as coinsurance and deductibles. Our tables take the major benefit limitations such as these into account in estimating costs. However, we cannot deal with every single coverage nuance or difference (such as which organs are eligible for transplantation, which models of particular medical devices are covered, or which specific medicines are covered). Nor can we assure that all plans will make identical medical necessity decisions in close cases—and they won't. Nor can we reflect extra benefits the plan may provide if, for example, it can save money by giving you more home nursing than its normal limitation on this benefit.