by Brian Swerdlow

Selecting the right Federal Employee Health Plan (FEHB) for you and your family is a crucial decision that impacts your healthcare coverage and finances. With numerous plans available, it’s essential to navigate through the options carefully to find the one that best meets your needs. Here are three critical steps to help you make an informed choice:

  1. Utilize Cost Comparisons

Start by using the yearly cost comparisons provided by FEHB guides. FEHB comparisons are personalized guides based on the information you provide, helping you identify plans where your costs are likely to be relatively low. These tools allow you to estimate your total healthcare costs, including premiums, out-of-pocket expenses, and potential savings. Doing this step helps narrow your choices to a handful of plans that offer the best value.

  1. Consider Special Needs and Benefits

Once you have a list of cost-effective plans, focus on any special needs, circumstances, or benefits that are important to you but aren’t reflected in the cost comparisons. For example, if you or a family member has a chronic condition requiring specialized care, ensure the plan adequately covers these needs. Look for benefits like maternity care, mental health services, chiropractic care, or specific medication coverage. Comparing features across different plans could help you decide which plans will work best with your unique healthcare requirements.

  1. Retain Your Preferred Doctors

Retaining your preferred doctors can be a significant factor in choosing a plan. Investigate whether your current doctors are within the network of the plans you’re considering. If retaining a specific doctor is crucial to you, this might outweigh other cost-saving benefits. In some cases, your doctor may have affiliations with multiple plans. Don’t hesitate to ask your doctor’s office about the plans they accept and which ones they recommend based on their experiences with different FEHB plans.

At this stage, it’s beneficial to compare the brochures of the shortlisted plans carefully. Underline critical points or parts of the plans that confuse you, and compare these points among the plans. Utilize the guide or the Office of Personnel Management (OPM) guide to find plan brochures for your area. You can search specific terms like “maternity” or “surgery” within the brochures to quickly locate relevant benefit details. Concentrate on the differences that matter most to you.

Making the Final Decision

After identifying the significant differences among the best plans, you’re ready to make your final decision. Writing out the most important ways the plans differ can help clarify your choice. These differences may not be strictly financial. For example, you might be choosing between a national plan and a Health Maintenance Organization (HMO). If the HMO costs less and offers better coverage for a benefit you need but means giving up a long-term doctor, there are ways to navigate this:

  • Check if your doctor’s affiliation is with both plans.
  • Consider using part of the money saved with the HMO to continue seeing your doctor out-of-pocket.
  • If you have multiple doctors you want to retain, the national plan might be worth the higher cost.

Ultimately, your best strategy is to select your plan using the estimated yearly cost for a family like yours. This strategy considers the unpredictable nature of high medical expenses. Use known, routine, predictable expenditures to decide how much to allocate to a Flexible Spending Account (FSA), but choose an insurance plan primarily for protection against unexpected, high costs.

An exception to this strategy is if you anticipate needing a specific, expensive service next year, such as surgery or maternity care. In such cases, contact the physicians you are considering and ask which plan networks they are in and which FEHB plans pay best for the care they provide.

FEHB Rates for 2024

Understanding the FEHB rates for 2024 is essential for making an informed decision. Here are the key details:

  • HMO (Regional Plans with Specific Service Areas):
    • Premium Rates: Available in an Excel file.
    • TCC and Former Spouse Rates: Available in an Excel file.
  • FFS (Fee-for-Service/Nationwide Plans):
    • Premium Rates: Available in an Excel file.
    • TCC and Former Spouse Rates: Available in an Excel file.

For 2024, the biweekly maximum government contribution for most employees and annuitants (72% of the weighted average) is:

  • $271.43 for Individual.
  • $586.50 for Individual Plus One
  • $646.18 for Individuals and their families.

The monthly maximum government contribution (72% of the weighted average) is:

  • $588.10 for Self Only
  • $1,270.75 for Self Plus One
  • $1,400.06 for Self and Family

The 2024 biweekly program-wide weighted average premiums with a government contribution are:

  • $376.99 for Self Only
  • $814.59 for Self Plus One
  • $897.47 for Self and Family

The monthly program-wide weighted average premiums with a government contribution are:

  • $816.81 for Self Only
  • $1,764.95 for Self Plus One
  • $1,944.52 for Self and Family

In some instances, the enrollee pays a higher share of premiums for the Self Plus One enrollment type than for the Self and Family enrollment type. Enrollees wishing to cover one eligible family member can choose either Self and Family or Self Plus One enrollment type.

 

By following these steps and considering the 2024 FEHB rates, you can make an informed decision about the best health plan for you and your family.

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