Choosing health insurance (any Fed employees?)

MamiJam

Any moms out there(especially Fed gov employees) willing to shed some insight on health insurance options?  I dread choosing health insurance because it just seems like I'm choosing between the lesser to 2 evils.  DH is in favor of an HMO plan because it's cheaper but I'm hesitant.  Then again some of the PPO plans I'm considering also have similar restrictions.  We don't normally see specialists or have any serious med conditions but you never know what the future holds.  How do you decide?

Sam78

I based my decision on what we normally use, so not necessarily the cheapest on premiums because they often have a higher deductible and/or co-pay.  You get to change plans every year, so if your needs change, you can re-evaluate, but do what you think you'll need for this year.

aocain02@yahoo.com

I'm not a fed employee but I am a government employee for a city with my insurance through the state's benefit provider and have the HMO/PPO choice. Honestly cost was my determining factor. The ppo is more than double the HMO cost for me. I am the only one covered through my benefits (DS is on dh's since there is no out o pocket expense and he only has the HMO choice). I have pretty stinkin good coverage. Cheap copays, quick turn around on referrals, and can self refer for obgyn. Well visit and annual checkups are free. For me the coverage between ppo and HMO are pretty comparable. I'd check the two plans out to see what is the best fit for you. You can always change during open enrollment if you aren't happy.

Artslvr

I am a Fed and have Aetna Open Access.  I originally chose it because it had some amount of coverage for infertility expenses, which clearly ended up not being an issue for us.  I do like that it covers all OB appts. fully and we paid areound $400-$500 for each kid when they were born, Aetna covered the rest.

FWIW, DD #2 had a c dif infection earlier this year and was hospitalized for four days.  She saw many specialists during her stay, and after.  The whole thing cost us around $250 which I thought was pretty good considering a four day stay and all those doctors.

thiswillbe

I'm a federal employee too and also have Aetna Open Access-- the "high" option (switched to "high" right before the twins were born because the hospital coverage is very different between the "basic" and "high" options-- make sure to read the details when you're choosing a plan). It's nice to not have to get referrals from anyone before seeing specialists.

Halo79RN

we used GEHA when ds did his post doc with the usda.  maternity was covered 100%, but we had to have any non stat labs through labquest ...  also, xrays /radiology (except u/s under maternity coverage) had to be paid by us until the deductible was met... $400 individual, $900 family.  most of the time we just had $10 copays for regular check ups (maternity was covered 100%).  I believe the monthly fee was around $300-400.

this was a few years ago... I'm sure it has changed.

when we first moved here, the first ins plan dh's employer had was an aetna plan that sucked.  they've switched to a better plan. but given you're with the gov't, the pool is bigger so you can get better coverage than a small college.

GL picking... it's always confusing when sitting and looking at the plans.  

 

snicksnack

If you can afford it go with the PPO.  I had an HMO and getting referrals and tests done was a nightmare.  The point of most HMOs is to manage your care so that you don't have to spend so much on tests etc... With a PPO if you don't like your doc etc... you can just get a second opinion with no issues.  An HMO is fine if you don't think you will get sick but if anything is wrong forget about it.  I was diagnosed with Crohns while on an HMO and almost died due to the fact they did not want to do the more expensive tests to determine what was wrong with me. 

BottomStar

Ditto PPs, I have the Aetna Open Access (High Option) Fed plan and it's great!  You don't need referrals to see a specialist and the co-pay is low.  I only paid the co-pay once for all my ob-gyn visits when I was pregnant and my only hospital costs were $150 a day with a max of $750.  We were there 3 days and paid $450 out of pocket.  The only problem I ever had was trying to get meds for my morning sickness because they wanted me to try all the over the counter meds first.  My Dr's office worked that out and I got the meds.  Their customer service is decent too, as far as insurance companies go.

SEOR

I have tried the BCBC Federal Standard and BAsic. We went with BCBS b/c it is one of the few that were national (we have family and friends all over and I want to be well covered no matter where we might be visiting).  In a nutshell, with Basic you need to go to preferred providers, you do NOT pay a deductable, you pay more for meds and cannot do mail away, the co-pays are slightly higher, you seem to get a bit more preventative and diagnostic care for less money (more chirpropractor visits, X-rays fully covered, dental cleaning and X-rays fully covered, etc...).  Basic is also less per paycheck.  Standard gives you some money toward things no matter what doctor or facility, but you still get the most coverage if you go with a preferred.  You have mail away pharmacy benefits and perhaps more rehabilitation (therapy), but I am not sure.  for most people I talked to, it came down to if you are on a lot of high dollar meds or if anyone in your family is.  If so, that is where the Standard shines.  If not, go Basic, but try for generic drugs, if needed.  With eihter one, a preferred provider stretches your dollar.  I have had noproblem finding preferred providers.  I have had issues getting straight answers as far as what prenatals are genric, what are mid-tier, etc...  IF you have a serious question, get the number of the rep to your agency/office. They know more and I had a co-worker who was able to get an error fixed quickly that way.  Also, we asked around our office and BCBS dominated.  However, that could be b/c of where I live and the affilications of the majority of the doctors.  If you have a favorite doctor, you could always see what plans that doctor uses...  Best of luck!

slwprincess

I'm a fed. We have the BCBS PPO plan and have been happy.  For my first pregnancy, we were on the Standard Plan.  I was naive and thought that if it cost more it must be better.  Ummm not so much.  Finally realized that the benefits are mostly the same on the Basic plan but the premiums are much less and there is no deductible.  We do pay a little more for copays but DH and I would much rather do that than pay so much more in premiums.  So far, I have been much happier on the Basic plan.  Seems to cover everything that we need.  Of course, I haven't given birth yet... last time we ended up getting slammed with a ton of unexpected NICU bills until we met our deductible b/c DS was born in Feb.  Pretty much everyone in my office uses BCBS or Mail Handlers but I know how overwhelming it can be.  Every year when they do the health insurance fair in our lobby my head starts spinning!!!

Torani

DH is a state employee (teacher) and we chose the HMO option.  I have had this HMO my whole life, so I like (and it was cheaper) and I know the system.  I also like that it is really easy to switch doctors if I decide I don't like mine.  I was not big on the idea of finding a private doctor that I can't really research and have no idea on if they are good or not.  I like knowing where I go for ER and for regular appointments, and both are less then 10 min from my house.  I love DH's union for negotiating awesome healthcare, since my prenatal care, delivery and well baby checks were all zero copay!