How to Choose the Best FEHB Plan For You and Your Family
There are three important steps to follow to narrow down the selection of plans:
- Use the Guide's yearly cost comparisons, which are personalized based on the information you tell us, to find the handful of plans where your costs are likely to be relatively low.
- Focus on any special needs, circumstances, or benefits that are important to you that aren't reflected in the cost comparisons.
- Consider how important it is to retain your doctor(s).
At this point, compare the brochures of these plans carefully. Underline key points, or parts of the plans that confuse you, and compare these points among the plans. It is very easy to use our Guide, or OPM, to find copies of plan brochures for your area. Then you can search on a word such as "maternity" or "surgery" or "chiropractor" in the brochure for each plan and find the benefit details in seconds. Probably the plans will be similar on most things, so concentrate on differences that are important to you.
When you have figured out the major differences among the best plans, you are ready to make your final decision. One way to do this is to write out the most important ways in which the plans differ. These differences may not be strictly financial. For example, suppose it turns out that your choice is between a national plan and an HMO. Let's say that our ratings show that the HMO costs $1,000 dollars a year less on average and has slightly better coverage for a benefit you need. But you are unwilling to give up a doctor you have been using for years. This seems to be an impasse, but there are several possible ways to resolve it. Perhaps your doctor is affiliated with the HMO—why not ask? Or consider using part of the money you will save by joining the HMO to continue going to your doctor and paying out-of-pocket (using a Flexible Spending Account will cut this cost by a third). Or you may have more than one doctor you want to keep and conclude that the national plan is well worth the higher cost.
The best strategy to choose a plan is to use the estimated yearly cost for a family like yours as the primary factor in plan selection. This considers that none of us can predict whether we may have a heart attack, a stroke, cancer, or other costly conditions that can strike unexpectedly. You should use your known, predictable routine expenses to calculate how much to put in a Flexible Spending Account, not to choose an insurance plan whose main purpose is to protect you against unexpected and high expenses. There is an important exception to this general strategy. If you know that you will need some particular service next year, and it is very expensive (for example, hip surgery or maternity) and likely to cost you tens of thousands of dollar, it makes sense to select the physician you would like to use (or several you are considering) and ask two simple questions: "What plan networks are you in?" and "In your experience, which Federal employee health plan or plans pay best for the care I need?" Sometimes the answer will be that all of them pay well. But sometimes the answer will be that only a few plans pay well. In that case, look first at these plans and choose one of them after you complete your detective work by reading the brochure section on your procedure, calling the plan, or checking with other people who have been in your situation. But do not forget that some other disease may strike, so factor in both known problems and overall ratings in choosing among these few plans.
You may be overwhelmed by details and confused by the choices you face. So here are some concluding thoughts based on some of the most common questions we have heard. Try to focus your decision on several key questions. Are you willing to join an HMO or a High Deductible plan? Do you expect big bills for an event such as surgery? Do you really want to have a benefit, such as chiropractic or hearing aid? Do you really "have to have" a doctor in the plan network? Perhaps you can afford a higher premium to get the benefits you want, or perhaps you cannot and must pick a plan that at least gives you good catastrophic protection.