When you absolutely must switch health plans

Not many people enjoy shopping for health insurance. There’s a reason Blue Cross, Aetna, Kaiser and GEHA brochures never make The New York Times’ bestseller list.

Dull, dull, dull. And there are more than 30 D.C. area plans (or 250 nationally) FEHBP plans with brochures, most of them apparently written by someone for whom English is a remote second language.

Each year during the health insurance open season (Nov. 9 through Dec. 14) federal workers and retirees must pick a health plan for the coming year. If they do nothing — which is what most do — they stay in their current plan. Even if benefits have changed, their doctor has left the network and their prescription drug benefit has changed.

Most people stay in the same health plan, year after year, even though many would save money and get better coverage if they shopped around. Like this fed, Lee M., who is fed up with his long-time plan:

“First I wanted to say thank you for all the great articles and information your site provides. I am a 17 + year employee of the federal government and often find information on your site before I get it from my agency.

“Wednesday’s column about changing health plans hit home. I thought I would share a little tidbit relating to the topic. I am one of those who has had the same health plan for countless years (Blue Cross Basic.) In the past few years, I felt they were becoming complacent or perhaps I was just tired of fighting with them regarding a class of very important (and common) prescriptions I take. Blue Cross would make me bounce around to other documented less effective drugs which eventually resulted in an expensive medical test and problem that cost them more than the original drug would have. Finally, I settled on an almost $200 per month co-pay drug that works well. Yesterday, I received a letter from them that they are no longer covering that drug at all and, here is the kicker, I must switch to the generic version to continue my coverage. That seems easy enough and heck it would save me money, so I call them and ask for the generic name. Well apparently there is no generic and they could not answer why I would get a letter telling me I have to switch to a generic that doesn’t exist. To complicate the matters they now want me to choose a drug from the list of ones which contributed to the problems and expensive testing last year.

“So I have to follow your advice and seek out a new plan. The medical condition which I am referring to is a very common one and I imagine BCBS will lose quite a few others over this. Ironically I just bit the bullet and signed up for BCBS dental yesterday for the first time before I received their letter. Now I will switch that too as I am one who once lost will not return.

So I am off to research. Thanks for letting me and other know about thr checkbook as I hope it will help in choosing a new plan.”

Walton Francis, who literally wrote the book on the federal health program (Checkbook’s Guide to Health Plans for Federal Employees), was the guest on yesterday’s Your Turn radio show. He read the above letter and said, you should absolutely shop around. As should most people.

Without knowing the specific prescription involved, Francis had this advice for Lee M.,

“First, checkout local HMO plans, most of which charge $30 to $35 for name brand drugs.

“Also, a high deductible plan such as Aetna or CareFirst is worth considering.

“Finally, be sure to check plan formularies on line to make sure your drug is covered at the ‘preferred name brand’ price.”

Nearly Useless Factoid

By Michael O’Connell

After English and Spanish, Chinese is the third most commonly spoken language in the State of New York.

Source: Mental Floss

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