Copyright 2000 The Washington Post
The Washington
Post
November 7, 2000, Tuesday, Final Edition
Correction Appended
SECTION: HEALTH; Pg. Z12
LENGTH: 1836 words
HEADLINE:
The Insurance Vote; Amid rising rates and changing coverage, it's time to cast
your ballot for the right health care plan.
BYLINE:
Gregory Mott
BODY:
With the presidential
campaign drawing mercifully to a close today, federal workers and others can
turn their attention to a different sort of election, one in which their choices
are more likely to have a direct impact on their lives.
Open season, the
annual period during which participants in the Federal Employee Health Benefits
Program (FEHBP) are free to make changes in their health care coverage, begins
Monday and continues through Dec. 11. Many other employers, both public and
private, allow workers to make coverage selections during the same period.
Like many people who obtain health care coverage through large
employers, federal plan participants can choose among a range of options: Those
in the Washington area can select any of 13 local health maintenance
organization (HMO) plans or one of the seven point-of-service programs (nearly
all of which include preferred provider options) available to FEHBP participants
anywhere in the world.
Past practice suggests that participants
generally greet this opportunity with a resounding yawn. Typically only about 5
percent of the 9 million people covered by FEHBP change coverage during the open
enrollment period, even though plans can differ dramatically in terms of
out-of-pocket costs to consumers and quality of care, according to Washington
Consumers' Checkbook, which publishes an annual guide for federal employees.
Checkbook and others who specialize in looking at this sort of thing suggest
that consumer confusion may play a role, either because people faced with a
range of choices end up thinking that all plans are basically the same or
because they decide that choosing which differences should be determining
factors is more trouble than it's worth.
Budget-conscious consumers may
be tempted to select a plan based on how small a bite it takes out of the bottom
line on pay day, but experts say that is a particularly bad idea. At the same
time, you can't even count on a high premium price as an assurance of quality:
Some plans offered under the federal program are inordinately expensive for
reasons that have little to do with the quality of care they provide.
In
selecting a health plan, the trick is to find the best price for the benefits
package that meets your needs.
Prices Are Trending Up
Many
federal workers have already gotten the bad news that premiums are on the rise
again, up 8.5 percent for FEHBP participants in HMO plans and 10.9 percent for
those in fee-for-service programs, according to the federal Office of Personnel
Management (OPM), which manages the program. This year's boost is the fourth in
a row; premiums paid jointly by workers and the government--which pays
three-quarters of the cost up to a specified limit--are up 33 percent since
1998.
The increase is consistent with a national trend cited in a
September report noting that premiums for employer-provided insurance rose 8.3
percent from spring 1999 to spring 2000, the sharpest increase since 1993.
The report by the Kaiser Family Foundation and the Health Research and
Educational Trust noted that the nationwide cost spike, largely attributable to
rising prices for prescription drugs, ended a period in which increases in
health care costs lagged behind the general rate of inflation. Findings from the
report, published in the September/October issue of the journal Health Affairs,
indicated that employers, many of them struggling to retain workers in a tight
labor market, were bearing the brunt of the cost increases rather than passing
them on in the form of higher employee premiums.
That is not the case
for federal plan participants. Those with family coverage in fee-for-service
programs will see their share of the premiums increase by an average of 14
percent next year. Those with family coverage in HMO plans will pay almost 7
percent more. In announcing the premium increases in September, OPM officials
said they had been forced to choose between increasing premiums and reducing
benefits.
With the price increases, federal workers will contribute an
average of $ 79 a month for single coverage and $ 174 a month for family
coverage. The Kaiser report, drawn from a survey of more than 3,400 private and
public employers, listed average employee contributions of $ 28 a month for
single coverage and $ 138 a month for family coverage. The federal government's
year 2000 contribution limits ($ 2,050 for single; $ 4,575 for family) roughly
equal the average outlays for coverage reported by the employers in the Kaiser
survey ($ 2,088 for single; $ 4,692 for family).
As health plan
participants brace for the latest premium increase, there may be more down the
road. Two recent surveys--one from the Washington Business Group on Health and
another from Hewitt Associates, a benefits consulting firm--predicted
significant premium increases in 2001, and the Kaiser report suggested that a
slowdown in the economy or a slackening of the job market could prompt employers
to shift a greater share of the financial burden to workers.
It's
important, however, to keep in mind that premium cost isn't the only
consideration. A plan may make changes that don't take any more out of a
participant's paycheck but require greater out-of-pocket outlays for medical
treatment. Plans may even cut certain benefits altogether while keeping upfront
participant costs relatively stable.
New Tax Benefits
For
federal plan participants, at least, there is some good news to go with the bad.
Federal workers recently won the right to pay their share of health
insurance premiums with pretax dollars, creating a potential average savings of
$ 435 annually and blunting the effect of this year's premium increase. Because
of income tax rules, that benefit is not available to retirees.
Also,
beginning in January, FEHBP participants will receive parity
for mental health and substance abuse treatment, meaning that
they will get the same co-payments, access to specialists and coverage for
medications and outpatient care in those categories as for other medical
conditions.
Another change likely to be welcomed by plan participants
even though it will have little or no impact on the bottom line is a
streamlining of the language describing the various offerings. OPM says it
undertook that effort in conjunction with insurers to make it easier to compare
the plans with one another.
As for plan quality, a certain amount of the
guesswork for FEHBP participants has been removed by the government's rigorous
screening process. All of the plans participating in the program have been
accredited by either the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) or the National Committee for Quality Assurance (NCQA),
two nationally respected organizations dedicated to assessing and reporting on
the quality of medical plans.
Some insurers have resisted submitting to
the accreditation process, arguing that comparative data can be subject to
misinterpretation and asserting that they provide sufficient data to consumers
upon request. But NCQA argues in the latest edition of its annual State of
Managed Care Quality report that the overall quality of health care coverage is
improving, and that the improvement is being driven by the scrutiny of
accrediting organizations. NCQA notes that accredited plans significantly
outscore nonparticipants in the 18 clinical measures it uses for rating plans.
These measures range from preventive care in the form of immunizations and
screenings to follow-up care for pregnancy, mental illness and heart attack.
Both NCQA and JCAHO offer consumer checklists that are designed to help
consumers choose among health plans, and OPM's Web site has a link to
PlanSmartChoice, which is similar but is specifically geared to federal plan
participants.
Washington Consumers' Checkbook's approach, as its name
suggests, is more focused on the bottom line. The group's 118-page guide is
loaded with charts and analyses examining the plans, looking at quality of care
and consumer satisfaction, but the distinction that has made the guide popular
with federal workers over the years is that it estimates total real costs for
coverage, including premiums and out-of-pocket expenses.
RESOURCES:
* Checkbook's Guide to Health Insurance Plans for Federal Employees,
2001 Edition, is available for $ 10.45 by writing to CHECKBOOK--Health
Insurance, 733 15th Street NW, Suite 820, Washington, DC 20005 or by phoning
202-347-7288. The book can also be ordered online at the organization's Web site
(http://www.checkbook.org/hig/fedguide.htm).
* The federal Office of
Personnel Management offers a wealth of information on its FEHBP Web page
(http://www.opm.gov/insure/health/index.htm), including a link to a tool for
comparing programs (http://www.plansmartchoice.com/FEHBP/welcome.asp).
*
The federal Agency for Healthcare Research and Quality offers fact sheets
designed to guide consumers in choosing and using health plans on its Web site
(http://www.ahcpr.gov/consumer/).
* The National Committee for Quality
Assurance Web site (http://www.ncqa.org/pages/hprc/index.asp) offers a tool that
enables consumers to create a "health plan report card" for managed care
providers they're considering. The site also offers the full text of the
committee's fourth annual State of Managed Care Quality report.
* The
Joint Commission on Accreditation of Health Care Organizations offers consumer
information on its Web site (http://www.jcaho.org/trkgen_frm.html), including a
checklist of questions consumers should consider in the process of selecting
health coverage.
CONSIDER YOUR OPTIONS
Washington Consumers'
Checkbook rates FEHBP plans for customer satisfaction using survey responses to
a series of questions on various aspects of medical care and coverage. Overall
quality is based on consumers' grades of the plans on a scale of zero to 10,
with 10 being the highest. Following is listing of plans available in the
Washington area ranked by the percentage of customers who gave them overall
ratings of 8 or higher:
D.C. Area HMO and POS plans:
MD-IPA: 69
Free State: 61
Capital Care: 55
Kaiser Permanente: 55
Aetna U.S. Healthcare: 48
GWU Health Plan: 47
U.S.
average for all plans: 59
National Fee-for-Service and PPO plans:
GEHA Benefit Plan: 82
NALC: 82
Postmasters: 81
Rural Carrier Benefit Plan: 81
Blue Cross and Blue Shield: 78
Foreign Service: 75
Mail Handlers: 73
Secret Service: 73
SAMBA: 71
Alliance Health Plan: 69
Association Benefit
Plan: 68
APWU Health Plan: 62
U.S. average for all plans: 75
Note: Checkbook's editors point out that the survey responses are based
on opinions and that the rating might be skewed disproportionate representation
among either satisfied or dissatisfied customers. They also note that the HMO
ratings should not be compared with fee-for-service ratings, if only because HMO
plans are local while fee-for-service plans are national.
CORRECTION-DATE: November 8, 2000
November
14, 2000
CORRECTION:
The Health section's Nov. 7
article on selecting health coverage incorrectly characterized the plans offered
in the Washington area. There are seven local health maintenance organizations
and 13 fee-for-service plans. The story also gave an incorrect telephone number
for Washington Consumers' Checkbook. The correct number is 202-347-7283. In
addition, an accompanying chart unintentionally omitted the Free State Health
Plan.
* "Too Anxious to Live an Ordinary Life" [Treatment of Choice,
Nov. 7] failed to properly identify Thomas Wise. He is a psychiatrist and
medical director of behavioral services for Inova Health System in Fairfax.
GRAPHIC: Illustration, david mclimans
LOAD-DATE: November 07, 2000 
