FEHBP enrollees generally pleased with health coverage

Government employees and retirees generally are satisfied with the health care coverage they receive through the Federal Employees Health Benefits Program, according to feedback from Government Executive readers.

More than 90 percent of respondents to an October Government Executive poll characterized their FEHBP coverage as “good” or “satisfactory.” The question received more than 1,200 responses. In answer to a separate question, a majority of readers (57 percent) considered their overall FEHBP costs, including premiums, co-payments and drug prescriptions, to be average compared to other national health insurance plans.

This year’s open season, during which federal employees can switch enrollments in health insurance plans, begins Nov. 12 and runs through Dec. 10. Based on the poll, most people don’t intend to switch plans -- a finding that could indicate enrollees are happy where they are, or just staying put because of inertia. Regardless, open season is a good time to shop around for savings, said Walton Francis, author of Consumers' Checkbook Guide to Health Plans for Federal Employees.

“It’s often the case that the more frugal plan does not have significantly inferior benefits,” Francis said. In other words, the more expensive plan isn’t always the best bang for your buck overall.

The cost of health care remains an important issue for most Americans and a politically hot topic with the continued implementation of the 2010 Affordable Care Act. FEHBP is widely considered a model health insurance program, but that doesn’t mean it’s immune to change or criticism. The Office of Personnel Management last month announced that premiums will increase an average of 3.4 percent in 2013; changes in the enrollee share of premiums vary from plan to plan. Increases in some of the plans, including the popular Blue Cross Blue Shield Standard option, are negligible. Still, some federal workers have complained that the cumulative increase in premium rates, co-payments and prescription drug expenses that they’ve experienced during the past few years is much more than the reported average, and it adds insult to injury on top of the ongoing pay freeze. But Francis said the annual average premium increase reported by OPM is “perfectly accurate” and people are free during open season to make different choices. “Anyone who thinks they have to be passive and take another hit to their wallet is not thinking straight,” he said. One reason people opt to stick with a pricier plan is the ability to go out of network for providers, Francis said.

Various factors typically affect health care premium rate increases, including an aging population, benefit changes and enrollees switching plans. OPM assesses annual increases in part by using a framework that assumes no one will change plans, though the agency knows there will be movement. “The premium experience was slightly different than we expected” in 2012, which partly accounted for the lower increase for 2013, John O’Brien, director of health care and insurance at OPM, told reporters during a briefing in September.

Another long-standing complaint from enrollees, and one that several Government Executive readers mentioned, was the lack of a self-plus-one option. FEHBP offers self-only and family coverage; those enrollees with spouses and no dependents must choose the family plan if they want coverage extended to their spouse. Some enrollees have balked at having to pay more for the family plan when they don’t have children, but Francis said a self-plus-one option would not be cheaper for enrollees. “If they got their wish, they would pay higher premiums,” Francis said, because that demographic consists largely of older, empty-nesters, who are more expensive to insure than a young couple with children. “OPM actuaries have confirmed that over and over,” Francis said.

OPM data show that the FEHBP enrollee pool skews older. And information gleaned from the Government Executive poll bears out that trend as well: Forty-eight percent of respondents identified themselves as between the ages of 47 and 59, while 37 percent said they were 60 or older.

(Image via Kladej/Shutterstock.com)