Fed Employees - BCBS vs GEHA

MrsGinDC

Fed Employees -- I am thinking about switching to BCBS Basic from GEHA during the next open season because I am thinking about TTC next year.  Anyone have any experiences with either plan?  From what I can tell it seems as though BCBS is the way to go for maternity care.  Thanks ladies! 

alliapistor

I have BCBS Basic and have been very happy.  When I priced out the various plans, it seemed to be the best for me based on my needs (weekly allergy shots, regular meds and see a number of specialists a couple of times a year).  For maternity care, I had an office visit copay at my initial appointment to confirm pregnancy and after that everything has been covered except for $150 for the hospital and a fee for circumcision.  That incudes all of my office visits, ultrasound at initial appointment, NT scan, anatomy scan, labs, and a recent ultrasound.

We initially saw a fertility specialist and my office visits were covered as regular specialist visits ($35 copay) and labwork was 100% covered.  I did have to pay for my HSG (I think 20% as an outpatient surgery).  If we had needed IUI or IVF, it wouldn't have covered the treatments but I think some of the meds would have been covered (I'm pretty sure that clomid and some of the common injectables are on their formulary, but you may need pre-authorization).

Overall, I am very happy with the BCBS Basic plan.  The main drawbacks are that you HAVE to go in network.  There is no coverage for out of network providers.  And there is not mail order pharmacy option.

SoonToBeMrsDTS

Maybe things have changed but we had GEHA when I had my first (5 years ago!!) and I was very happy with the coverage. I only had to pay a co-pay once and it was for blood work. I did have a hard time find a pediatrician that would take GEHA so we switched to BCBS a few months after DD was born. It was a little more expensive but worth it since everyone takes it. 

BabyHatch

I think we have BCBS Standard which has been FANTASTIC. I literally did not pay a dime out of pocket during my pregnancy (and I ended up high-risk with bi-weekly monitoring at the end).

MrsGinDC

Good to know -- thanks ladies!  I think I'll definitely have to look both of them side by side when open season starts again.  

firegirle1

I had GEHA for years and still think it was the best plan I ever had.  I was not C though. 

mamaZbo

I am a Fed and have Kaiser. I like it so far, only a $15 co-pay up front and $100 for the hospital and everything else has been covered. I also like the convenience of everything being in one place--OB, lab, sonogram, pharmacy, etc. Saves me a lot of time.

cecilyandgautam

I'm on BCBS Basic and the co-pays for prenatal check-ups & lab work are $0. The co-pay for delivery is $150 per admission (so I guess if you have a false alarm, then you could pay this fee more than once). Co-pays on your baby's check-ups are also $0. Talking to friends on non-gov plans, I think this is really reasonable!! The list of in-network providers is really long and you have a ton of options. If you want to go with a small OBGYN or midwife practice that delivers in hospital or if you want to deal directly with a hospital, that's totally covered. The two covered birth centers within driving distance for me at BirthCare in Alexandria and Family Health & Birth Center in NE DC. There's at least one covered one in MD suburbs as well. Further options: any in-network provider is fully covered regardless of where you deliver. So, if you want to do a home birth, you could sign up with BirthCare and their in-network midwives would be covered to assist you with a home-birth. Call ahead of time of course to verify but this is what I was told via phone call with them.

BUT, if you want to go out of network (ie - if you want to use the new NOVA Birth Center), then you are not covered at all. In that case, I would recommend getting BCBS Standard so that your co-pays are 20% rather than paying fully out of pocket for the full fee. If you're going to traditional hospital route though, I think all the local hospitals are covered.

I initially had a hard time navigating my options with BCBS and thought no birth centers were covered but they are! Just give them a call and there's actually a ton of flexible options. I love the plan and so far my prenatal care has cost me $0, except for Rx co-pays (brand-name prenatal vitamins have co-pay of $40; generic vitamins have co-pay of $10). Can't really beat that.

PS - if you want to go with BirthCare, sign up as soon as you conceive - I had to be on a waitlist for a couple months.