How to Find the Best Health Plan During Open Season

Finding the right health plan is always tricky. Costs and benefits can change from year to year and needs are often unpredictable. But in 2022, there’s one change to health coverage, including the Federal Employees Health Benefits program, that could have a positive impact on almost every beneficiary. Last year, Congress passed the No Surprises Act, which takes effect on January 1. Under the new law, surprise billing is banned for emergency services. That means patients will pay no more for emergency care than what they would have paid to receive care in-network. The law also bans prior authorization requirements for emergency services whether the provider is in-network or not. 

That increased cost predictability during emergencies should be welcome news to all feds. To further prepare for inevitable health care surprises, there are six questions federal employees should ask themselves every year.

1. Is my plan still available? Several HMO plans left the FEHB program in 2022, and one national plan, United Advantage, will not be available this year.
2. Are there new plans to consider? There are a handful of HMO plans newly available to federal employees in 2022, including HealthKeepers HDHP offered in parts of Virginia.
3. Are my doctors still in network and are my prescriptions still on formulary? It’s always a good idea to check to receive the lowest possible out-of-pocket expense from your plan.
4. How much did my premium go up? The enrollee premium share for federal employees increased 3.8% on average. However, some plan premiums stayed the same, and some even decreased. Make sure to check to see how you’ll be impacted in 2022.
5. Are the same benefits available in my plan at the same out-of-pocket expense? Plan benefits can change every year, new benefits can be added, and existing benefits can be removed or cost you more out-of-pocket. Check Section 2 of the official FEHB plan brochure to see if any important benefits have changed in your current plan. 
6. What enrollment type should I choose? Couples and other two-person families should check to see whether Self and Family enrollment is less expensive than Self Plus One enrollment. There are 98 FEHB plan options this year where Self-Family enrollment is less expensive.

Feds looking to save money on their health insurance have a number of options: 

Switch Plans: The easiest way to save money is to find a different plan—and a less expensive plan may very well be just as good or better than what you have now. Around 5% of federal employees will switch their health plan during Open Season. We know from counseling thousands of them over the years that many stay in expensive plans when better, less expensive options are available. 

Our 2022 Guide to Health Plans ranks plans on estimated yearly cost, the combination of known expense (premium) and expected out-of-pocket costs based on the user profile. Below, we show that a Washington, D.C., area family of four with average expenses could save about $3,700 in annual costs by switching from Blue Cross Standard to GEHA Elevate. There are other great plan bargains available and it only takes a couple of minutes to see how your existing plan compares to other options.

Consider a High Deductible Health Plan: In most cases, an HDHP plan is the least expensive option available, but far too few federal employees enroll in them. Nobody likes a high deductible or not knowing what you’ll pay for a healthcare expense before the deductible. But keep in mind that HDHP plans tend to have lower premiums than popular PPO options and you can find out the cost of any healthcare expense by calling the health plan.

HDHP plans have a pre-funded health savings account (HSA), and the key to maximizing the plan’s full potential is to try to preserve or even add to the plan contribution every year. 

There are two ways to do this. First, if you’re switching from a more expensive PPO plan to an HDHP plan, contribute any premium savings to the HSA instead of pocketing it. Any money you put into the HSA is triple tax advantaged—you pay no taxes going in, investments grow tax free, and there are tax-free withdrawals when used on qualified healthcare expenses. In 2022, the maximum contribution to an HSA is $3,650 for individuals and $7,300 for families. Second, sign-up for a limited expense health care flexible spending account (LEX HCFSA). This specific FSA is allowed while having an HSA and can be used for any out-of-pocket dental or vision expenses. Having those expenses covered will increase your chances of not fully using the plan HSA contribution. 

If you can keep the HSA plan contribution invested, it can grow quickly. A family that is able to keep the $1,800 GEHA HDHP plan contribution, and each year thereafter, could have $25,000 or more saved after 10 years.

Sign-up for a Flexible Spending Account: Every active federal employee should have an FSA. Everyone will generally have at least some predictable out-of-pocket medical expenses in the coming year, so why not save 30% on those expenses? The only good reason to not have a FSA is if you’re enrolled in an HDHP/CDHP plan, and even then you’re still allowed to have a limited expense FSA for dental and vision expenses.

Retirement Considerations

Retirees and soon-to-be retirees should look at Medicare Advantage options available to them. United Choice Retiree Advantage plans available in about half the country have the lowest expected yearly costs for retirees. Those plans offer a generous Medicare Part B premium reimbursement ($148.50 per month) and have zero out-of-pocket costs for covered medical services outside of prescription drug copays. 

There are also three nationwide Medicare Advantage options open to all employees next year: Aetna Advantage, APWU-High, and MHBP Standard. 

Enrollment for the Medicare Advantage plans is a three-step process.

1. Enroll in Medicare Part B. This step can take the longest, so it makes sense to start here. Medicare Open Season ends one week before FEHB Open Season on December 7th so you’ll need to act fast to join a Medicare Advantage plan.
2. Enroll in the FEHB plan that corresponds to the Medicare Advantage plan you want to join.
3. Call the carrier to enroll in the Medicare Advantage plan. You’ll need to be on the FEHB plan roster before you can do this, so wait a couple of days after you’ve enrolled with OPM. 

Other Factors to Consider

FEHB plans are continuing to increase health and wellness benefits. Many plans offer tobacco cessation programs. Some offer dental, vision, hearing aid, and LASIK discounts. The Kaiser Prosper DC plan offers up to $425 to both the plan member and enrolled spouse for completing a total health assessment, biometric screenings, and having a COVID-19 vaccination. United health plans offer the Peloton app for free to members. If you can’t decide between a couple of different plans, make sure to consider the wellness benefits of each to help you make a final decision. We’ve included the most important of these benefits in the online version of the 2022 Guide to Health Plans.

Kevin Moss is a senior editor with Consumers’ Checkbook. Checkbook’s 2022 Guide to Health Plans for Federal Employees will be available on the first day of Open Season, November 8. Check here to see if your agency provides free access. The Guide is also available for purchase. Government Executive readers can save 20% by entering promo code GOVEXEC at checkout. Dallen Haws, a financial planner and host of the “Plan Your Federal Benefits” YouTube channel, contributed to this piece.