To the extent that people get emotional about their health plans, some people love health maintenance organizations, while others wouldn’t touch them, much less be in one, with a 10-foot pole. Some people don’t like the HMO approach. Others love it, provided their favorite doctors are in its network.
Most of the pros/cons of HMOs are geographic. For instance…
In the metro Washington, D.C. area, HMOs offer some of the best coverage at the lowest premiums. Copayments are reasonable and some have facilities that can handle virtually all of your medical needs. But there are other places where HMOs are less attractive (make that far less attractive) than nationwide fee-for-service plans.
There are places like Detroit, a great comeback city, but not necessarily where you want to choose one of the HMOs participating in the federal health plan, according to Walton Francis. He’s editor of Consumers’ Checkbook Guide to Health Plans for Federal Employees and is generally a fan of HMOs. Especially in the Washington metro area. But in other places, like Detroit, not so much.
We got this question from Robert D., who retired two years ago after 33 years with Uncle Sam. He said he listens to health insurance expert Francis, who will be our guest Wednesday at 10 a.m. on our Your Turn radio show. Robert says it is irritating and confusing to have to go to so many websites to check out health plans. And he has questions about specific plans in the Detroit area. We put the question to Francis and here’s what we got:
“There is one website you haven’t tried and should consider. Consumer’s Checkbook, at www.guidetohealthplans.org, compares all the FEHBP plans. I asked Francis about your situation and he says that all the Detroit area HMOs are very pricey and that you could save over $1,000 a year in some other plans. He suggests you pick out just a couple of national plans and compare their benefits and premium costs. Possible choices would be APWU Consumer-Driven and GEHA standard. There are also several others that would save you almost as much such as Blue Cross basic.”
By contrast, HMOs in the D.C. metro area are rated as best buys according to Checkbook’s Guide. Kaiser standard and high-option premiums for a self-only plan are $1,510 and $1,980, respectively. CareFirst HD (high deductible) and United Health Care HD and Aetna Open Access basic are also highly rated, and with low premiums.
Top-rated fee-for-service plans (if you use their network) are the NALC consumer driver, GEHA HD, APWU CD, the Foreign Service plan, MHBP HD, and GEHA standard and Blue Cross basic. Nonpostal workers and retirees are welcome in the NALC (letter carriers) and APWU (postal workers) union plans. Depending on their jobs, many feds outside of the State Department and USAID are also eligible for the Foreign Service plan.
As Francis says, all the plans are good, but some just cost too much.
You have until close-of-business next Monday to pick your health plan. Shopping can be a pain, but it could be even worse (or more expensive) if you pick — or more likely stay in — the wrong plan.