The reality of federal health benefits.

obamacare, congress health insurance

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All permanent federal employees, other than postal workers, receive the same health coverage options. The bailiff at the Federal Courthouse gets to choose from the same list as the judge. The Senator and the Senator’s secretary get the same choices. Contrary to popular belief and despite it being public record for decades, easily accessed on the internet, the options are not “plush” as a commenter on another site described recently.

They all are covered under the Federal Employees Health Benefits system, Program. The same options that will now be available to anyone via healthcare.gov come January first. Yes, you can have the same “gold-plated” insurance policy that certain news organizations over exaggerate. Health care exchanges are available nationwide, I would like to pull back the curtain. Below is my personal relationship with FEHB.

I am the spouse of a government employee. We chose from is the same list that Congressman Derek Kilmer chose from when he assumed office in January. Hypothetically speaking. I have not verified with the Congressman’s office if he subscribes to FEHB. FEHB is divided by government designated localities. Insurance providers have to create plans that meet specific standards and offer competitive rates. We have the opportunity every year (it’s called “open season”) to change plans without cost. We opted for this about 7 years ago after our younger daughter was born. She has multiple disabilities and we couldn’t care for her properly within the approval constraints of the non-profit HMO. We changed to a preferred provider organization (PPO) so we could get second opinions without referrals. When worked out dollar-for-dollar, the cost is about the same. It cost more in the premium – a lot more – but I did the math on prescriptions, co-pays, coinsurance, etc, it broke even for us. It was the opposite for my brother. He spends less on the HMO than the PPO. Every family is different.

There are many types of health plans to choose from and every plan offers a standard option and a high option. The standard option is what most would consider catastrophic coverage. Low premiums, high deductibles, just the basics are covered until you meet the out-of-pocket expenditure to activate the plan. Deductibles average $3000 for a family in my area. That is great of you are all healthy. You still have copays at office visits and for prescriptions. When broken down by what we pay in premiums and what we pay in deductibles and copays, the cost broke even for us despite the increased premium. Doing the math and reading the coverage information is very important.

High option plans are the opposite. The coverage is available immediately, but you pay a higher premium. Currently, $266.00 biweekly for our family plan. Plus, $30 office visit copays and pharmacy copays based on the plan’s formulary. Our out-of-pocket maximum is $5000 for our family. That is below the catastrophic tax deduction threshold for most middle-income families. We’ve hit that max every year that we have been on this plan. We still have to pay office visit and pharmacy copays.

On average, we pay $8000 per year in medical costs, not including premiums. Our premiums are not tax deductible. Which is fine by me, because they come out pre-tax. Every other Senator and member of Congress has these same options. There is no such thing as glamourous health care when you are talking about the federal government. Ask the next military family you encounter about cattle-call appointments.

 

As of January 1, 2014, Congress will no longer be eligible for Federal Health Employee Benefits. They are being put out into the open market that their constituents buy insurance in. They will be allowed to go through their state’s health insurance exchange, just as any other American can do right now. They will be adding up their income, calculating premiums along with the umber of office visits made and prescriptions cost. We are headed one more step in the right direction.

 

 

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Author: Astacia Carter

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