Your health plan vs. the law of averages

Workers and retirees in the Federal Employees Health Benefits Program have several choices: They can shop around, talk with their primary physicians, or, like m...

Depending on what happens to you and your loved ones next year a family of four could spend anywhere from $3,480 — the premium for a Kaiser Permanente standard HMO — to as much as $24,940 out-of-pocket if you have the Special Agents Mutual Benefit Association high option plan and your family has a catastrophic health or accident year.

On the other hand, if 2019 is an average medical year for you and yours, the Consumers Checkbook Guide to Health Plans, says your family could expect to wrack up bills of $3,840 to as much as $12,260 in the Aetna Open Access High option plan, or $11,010 in the SAMBA high option.

In between those two extremes are a wide range of health plans and options, including 20 to 30 in the Washington-Baltimore area to choose from. And in-between those two extreme premiums plus the maximum out-of-pocket liability, you could face $7,610 in the Kaiser high option and $9,510 for  Aetna Direct CDHP, to $17,650 for the Aetna Open Access High option or $20,490 in the SAMBA high option for a family of four.

So there is a lot of wiggle room.

Workers and retirees in the Federal Employees Health Benefits Program have several choices: They can shop around, ask friends, consult the Checkbook Guide or the Office of Personnel Management web site. They can talk with their primary physicians office to find out which plans work best for them. Or, like most people they can do nothing — stay in the plan they joined in 1986, or five years ago. That’s what most people do.

All the health plans are good, especially when feds and postal workers retire and their spouses’ private sector coverage goes away. But some simply cost too much, in large part because so much of the aging federal workforce and retiree community is packed in one of two plans. Again, they are excellent, but because of the”adverse selection”  — too many unhealthy older people — in the plan the premiums have gone up big time.

To help you pick the best plan on the job, many federal agencies have subscribed to the Checkbook online shopping guide for you. You can easily compare plans, see if your doctor(s) is in the network next year and look up benefit changes. My recent columns on best-buys and shopping will give you expert advice from Checkbook’s Walton Francis. And listen to the Your Turn radio show to get all episodes dealing with open season.

Nearly Useless Factoid

By Amelia Brust

Walruses can sleep on land for up to 19 hours and can swim for up to 84 hours straight.

Source: NBC News

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