Questions to Ask When Choosing an FEHB Health Plan for 2023

A previous column discussed the various types of FEHB health insurance plans available to federal employees and retirees to choose from. These plans include fee-for-service (FFS), preferred provider organization (PPO), point of service (POS), consumer driven health plans (CDHP) and high deductible health plans (HDHP) usually associated with a health savings account.

No doubt employees and retirees have many plans to choose from. OPM provides an FEHB plan comparison tool that allows employees and retirees to compare one health insurance plan to another health insurance plan.

In choosing a health plan for 2023 for themselves and their families, an employee or retiree is encouraged to evaluate their specific medical needs in order to help select the health plan that best addresses those needs. This column presents some of the questions they should be asking to find the most appropriate FEHB health plan for 2023.

There is certainly more than just premium cost when choosing a health insurance plan. The recent surge in inflation has exacerbated healthcare affordability problems. The portion of the FEHB premiums that employees and retirees will be paying (25 to 28 percent) will be increasing during 2023 on average 7.2 percent over 2022 premium rates.

The nation’s problems with inflation have spilled over into the medical sector. Individuals are reporting that higher medical expenses are causing challenges with healthcare affordability. In the past 12 months, 14 percent of the 1,140 individuals surveyed by a Harris Poll said they canceled or postponed plans to see a healthcare specialist. One in 10 respondents said they canceled or postponed plans to take a prescribed medication or to get their annual physical.

Another sign of high inflation as it relates to the healthcare industry is that inflation makes it difficult for individuals to access mental healthcare.

As the price of health care and basic necessities continue to reach record highs, federal employees and retirees are forced to make tough decisions that may affect their health and well-being. This is particularly important for retirees who over time during their retirement will likely be incurring more medical expenses.

It is therefore crucial that federal employees and retirees who are enrolled in the FEHB program ask questions with regard to their health care, both for 2023 and planning ahead for their retirement.

Among the important questions to be asked:

1. If I am satisfied with my current (2022) FEHB health plan and the plan meets my medical needs, why would I want to change plans for 2023?

2. Should I try to insure for most of my medical expenses or just the larger ones?

3. How much of a deductible, copayments and coinsurance am I willing to spend for myself and my family?

4. Knowing that I will have out-of-pocket expenses including deductibles and copayments, what is the best way to pay these out-of-pocket expenses? One recommendation is by enrolling or reenrolling in a healthcare flexible spending account (HCFSA) offered through FSAFEDS.

5. If I (and members of my family) did not incur much in medical expenses during 2022, then would it make sense for me to enroll in a High Deductible Health Plan (HDHP) associated with a Health Savings Account (HSA)? HSAs can offer benefits both currently and in the future, including retirement?

6. What happens in I go outside the provider network of the health plan I am thinking about enrolling in? How much will I have to pay for my care and for my family’s care?

7. Are the doctors, hospitals and other health care providers that I used during 2022 continue to be in the network if I remain in my current FEHB health plan during 2023?

8. Both for my current plan or if I change plans for 2023, what are the procedures for getting care and being reimbursed in an emergency situation, both at home and out-of-town?

9. Does the plan I’m currently enrolled in reimburse me for medical procedures, such as acupuncture or chiropractic treatment. If not, would another plan I am considering reimburse me for these medical procedures?

Some Questions for Employees Within 5 to 10 years of Retiring from Federal Service

1. Am I aware of the rules with respect to a federal employee retaining FEHB program health benefits in retirement, including:

a. The “five-year” rule? An employee must be a participant in the FEHB program, either through their own coverage or included on a family member’s enrollment, such as a spouse who is also a federal employee. Five-year period is five consecutive years ending on the “effective” date of an employee’s retirement from federal service.

b. The rule for my spouse to retain FEHB health benefits in the event I predecease my spouse? A spouse who is not a federal employee or a retiree would have to be currently enrolled on the employee’s or retiree’s FEHB plan at the time of the employee’s/retiree’s death and the employee must elect to give the spouse a full or partial survivor annuity (CSRS or FERS).

c. The rule when my spouse can be added to my FEHB health plan when my spouse currently has his or her own health insurance? If my spouse is not currently enrolled on my FEHB health plan because he or she is enrolled in his or her own health insurance plan, when can I add my spouse to my FEHB health plan? Answer: Open Season.

2. Am I familiar with the rules regarding Medicare, including:

a. What are the parts to Medicare?

b. Am I required to enroll in Medicare?

c. Why should I enroll in Medicare and when should I enroll?

d. Do I understand how my FEHB program health plan coordinates with Medicare and in particular, why I do not have to enroll in a private Medicare supplement plan or a private Medicare Advantage plan?

NOTE: Federal Retirement recently presented a series of Medicare columns. Those employees who are within five years of retirement eligibility and current federal retirees are highly encouraged to read of those columns (see list below) in order to get a better understanding of how FEHB health plans coordinate with Medicare. Federal retirees who enroll in Medicare can save thousands of dollars during their retirement by being enrolled in both Medicare and an FEHB health plan considered to be a Medicare supplemental plan. Federal retirees who enroll in Medicare do not have to purchase a private Medicare supplemental plan or a Medigap plan.

Medicare Columns:

• How Medicare Works and Minimizes Federal Retiree Medical Expenses
• Medicare Open Enrollment Period: What Does It Mean for Federal Retirees?
• Understanding the Three Enrollment Periods for Medicare and the Late Enrollment Penalty
• Deciding on the Right Choice for Medicare Enrollment
• Medicare Part B and Appealing High Premiums
• What Federal Retirees Need to Know About Medicare Part D