Will My FEHB Plan Pay for That?
Most plans limit reimbursement for most of the following services. Current employees can cover any of them through a Flexible Spending Account.
- Dental care—Only some plans cover dental care. We indicate which health insurance plans pay for routine and accidental dental expenses and show the better benefits with a "Yes." Our Guide provides dollar ratings of these plans along with the FEDVIP dental plans. The FEDVIP plans charge a premium but offer stronger benefits. Nonetheless, our ratings show that for most people joining an FEHB plan with modest dental benefits, and no extra premium, is a low-cost option for routine care.
- Vision care—All plans pay for medically necessary care of your eyes, such as cataract surgery. Some national plans pay much of the cost for eyeglasses or contact lenses through discounts at some retail chains. A few pay for examinations to determine the prescription you need. Among HMOs, many pay just for an "Exam," and some for most of the cost of glasses or contact lenses ("Yes" in our Guide). You may want to join one of the FEDVIP vision plans but a combination of prudent shopping and a Flexible Spending Account will often match the value of the standalone plans.
- Chiropractic services—Most plans reimburse some chiropractic services. The medical establishment has traditionally viewed chiropractors unfavorably because chiropractors are not trained as medical doctors. However, chiropractic services have been proven useful in treating some muscle, back, and joint problems. We use the label Yes for plans that pay for 20 or more visits at a cost of no more than $20 a visit.
- Acupuncture—Another non-traditional treatment that an increasing number of plans reimburse, often for a dozen or more visits.
- Hearing aids—Most plans pay for diagnostic hearing tests performed by a physician or audiologist, and all pay for medically necessary treatment for hearing problems. At OPM's urging, most plans now pay for hearing aids for both adults and children, and others for children only. In our Guide, a "Yes" indicates both a relatively generous allowance, and coverage of both children and adults.
- Infertility treatment—OPM has recently urged plans to add or improve infertility benefits, and all now cover artificial insemination and IVF fertility drugs. A few dozen now offer at least some coverage for in vitro fertilization, but most IVF coverage is found in HMO plans and varies considerably depending on what state you live in. There is one open enrollment national PPO plan exception . Blue Cross Standard now provides up to $25,000 per year for assisted reproductive technology (ART) procedures, including IVF. Keep in mind you still face considerable out-of-pocket costs from the infertility benefit cost share charged by the plan. Generosity varies so you should compare brochures or consult providers before choosing a plan. Fertility physicians and clinics are likely to know which plans best cover their services.
- Diabetic supplies—Some plans cover drugs but do not cover the cost of syringes and/or special testing supplies and kits needed by diabetics. Even for the plans listed as Yes, a diabetic should check brochures to determine the precise coverage the plans provide.
- Durable medical equipment—All national plans pay for prostheses, or artificial limbs. Some plans limit such coverage. Some plans also fail to pay for the purchase or rental costs of hospital beds, walkers, and other equipment you may need while recuperating from surgery or illness. Others pay only a limited benefit, such as 50 percent of the cost.
- Nurse advice—Most plans let you call a service to discuss medical problems that confuse you. Nurse advisors can greatly assist you in deciding, for example, whether to call a doctor and, if so, which specialty you need. Nurses can also advise you on handling minor medical problems of all kinds, on compliance with your medication needs, and diet and health, and on other issues. For plans that offer this, we enter the telephone number of the advisory service.
With rare exceptions, no plan will pay for any of the following expenses and we do not cover them in our comparisons (however, some of these expenses are covered by Flexible Spending Accounts and Health Savings Accounts):
- Cosmetic or Plastic Surgery—Except after accidents or a disfiguring illness
- Custodial Nursing Home Care—Or any kind of rest care
- Personal Comfort Items—Telephone or television while in the hospital
- Non-prescription drugs—Over-the-counter drugs such as aspirin
- Medical care fully paid by another insurance carrier
- Care that is not medically necessary
- Experimental care—Clinical trials are partly excepted
- Medical expenses that are higher than the plan allowance—Or what the plan has determined to be reasonable
- Medical expenses incurred before joining or after leaving a plan