Jeffrey Wade
Federal employees in the US have access to health insurance through the Federal Employee Health Benefit (FEHB) program, which was established in 1959 and is the largest employer-sponsored health benefits program in the country. The program covers nearly 8.3 million federal employees and dependents, and offers a wide range of health plans, including Consumer-Driven, High Deductible, Fee-for-Service (FFS), Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO) plans. Federal employees typically share the cost of their health plan premium with the government and may also have to pay deductibles, copayments, or coinsurance. The best plan for an individual may depend on factors such as cost, coverage, and in-network providers.
| Characteristics | Values |
|---|---|
| Number of federal employees covered | 8.3 million |
| Eligibility | Federal employees, retirees, and their survivors |
| Plan options | Consumer-Driven, High Deductible, Fee-for-Service (FFS), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) |
| Cost structure | Federal employees typically share the cost of premiums with the government and may also pay deductibles, copayments, or coinsurance |
| Flexibility | Ability to switch plans during Open Season, ability to choose between Self and Family enrollment or Self Plus One enrollment |
| Coverage | Includes access to a wide range of health services, with specific benefits varying by plan |
| Convenience | Online tools available to compare costs, benefits, and features of different plans |
| Additional benefits | Health Savings Account (HSA), Flexible Spending Account (FSA) options, no surprise billing for emergency services |
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What You'll Learn
Kaiser: cheap premiums, copays for most things
Kaiser Permanente is an HMO plan with a Medicare contract. It offers a variety of plans to help fit your needs and budget. All of them offer the same quality care, but the way they split the costs is different.
Kaiser Permanente offers Bronze, Silver, Gold, and Platinum plans. The Bronze plan has the lowest monthly premium but the highest deductible and out-of-pocket costs. This plan is a good choice for healthy people who rarely see the doctor but want protection in case they get injured or sick. The Silver plan has a moderate monthly premium, deductible, and out-of-pocket costs. This plan is suitable for generally healthy people who are willing to pay a bit more each month to have fewer out-of-pocket expenses. The Gold plan has a higher monthly premium but a lower deductible and out-of-pocket costs. This plan is a good option for people with dependents who use health care services regularly throughout the year. Lastly, the Platinum plan has the highest monthly premium but the lowest deductible and out-of-pocket costs. This plan is ideal for people with known health issues who require frequent specialty care, tests, and prescriptions.
Kaiser Permanente also offers HSA-qualified deductible plans, which allow you to set up a health savings account (HSA) to pay for health costs like copays, coinsurance, and deductible payments. This account is not subject to Federal income taxes, and any remaining money at the end of the year will roll over to the next year. Additionally, they offer catastrophic plans with very high deductibles and low monthly premiums, covering limited preventive benefits. These plans are available for people under 30 and those over 30 with a hardship exemption.
Kaiser Permanente's Senior Advantage plans for Federal Members offer better benefits and lower out-of-pocket costs compared to FEHB benefits alone. There are no deductibles, and copays are lower for most covered services and some prescription drugs. For example, you pay only 2 copays for up to a 100-day supply of most drugs through their mail-order program.
Overall, Kaiser Permanente provides a range of plans with different cost-sharing structures to meet your specific needs and budget. Their plans offer quality care while helping you manage your health care costs effectively.
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GEHA: good for singles, vision and dental benefits
Federal employees have access to the widest selection of health plans in the country. One of the most popular options is GEHA, which has served over 2 million federal employees, retirees, and their families for over 85 years. GEHA is the largest benefits association for federal employees and offers five FEHB plans to choose from.
GEHA is a good option for singles because of its wide range of consumer protections and the flexibility it offers. For example, if you are enrolled in both FEHB and Medicare, GEHA allows FEHB to be the primary payer. Additionally, GEHA offers a tailored Medicare Advantage (PPO) plan in partnership with UnitedHealthcare (UHC) that can enhance your coverage and add benefits at no additional cost.
GEHA also stands out for its vision and dental benefits. If you are enrolled in a Federal Employees Dental/Vision Insurance Program (FEDVIP) Dental Plan, your FEHB plan will be the primary payer. GEHA also offers extra benefits, including drug coverage and prescription costs.
To choose the best plan for your needs, you can talk to a GEHA FedViser, who can help you navigate the options. GEHA also has a Customer Care team that can assist with benefit coverage questions and locating a provider. You can reach out to them by phone or live chat during their operating hours.
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BCBS Basic: good for families, reasonable out-of-pocket expenses
Federal employees have access to the widest selection of health plans in the country, thanks to the Federal Employee Health Benefits (FEHB) program. This program is sponsored by the U.S. Office of Personnel Management and covers nearly 8.3 million federal employees and their dependents.
One of the health insurance options available through the FEHB program is the Blue Cross Blue Shield (BCBS) Service Benefit Plan, which offers both FEP Blue Standard and FEP Blue Basic options. The BCBS Basic option is a good choice for families, as it provides reasonable out-of-pocket expenses.
For example, under the BCBS Basic plan, members who require a covered transplant will only pay a $250 per day copayment (up to a maximum of $1,500) for the transplant period. Pre- and post-transplant services performed in Blue Distinction Centers for Transplants are also covered by the plan, with no additional costs for included professional services.
The BCBS Basic plan also offers a Medicare Reimbursement Account, allowing members to get up to $800 back per year. This plan is available to all federal employees, tribal employees, and annuitants who are eligible to enrol in the FEHB program.
When considering health insurance options, it is important to look at the total benefit package, service and cost, and provider availability, to ensure the plan meets your specific needs.
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FSBP: best for those based overseas
Federal employees typically share the cost of their health plan premium with the government. Depending on the plan, employees may also have to pay deductibles, copayments, or coinsurance. The Federal Employee Health Benefit (FEHB) program offers the widest selection of health plans in the country.
The Foreign Service Benefit Plan (FSBP) is a great option for federal employees based overseas. FSBP is available to employees of the following agencies, if they are assigned overseas or to US possessions and territories:
- Department of State (Foreign Service and Civil Service)
- Department of Defense
- Department of Homeland Security
- USAID (Foreign Service and Civil Service)
- Foreign Commercial Service (Foreign Service and Civil Service)
- Foreign Agricultural Service (Foreign Service and Civil Service)
- CIA, NSA, and other intelligence organizations
AFSPA is the self-funded carrier of FSBP and performs the customer service function for the Plan. Claims and clinical functions of FSBP are administered by Aetna. Prescription coverage for the Plan is administered by Express Scripts. FSBP has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) since 2016.
FSBP covers visits to any doctor outside the US and Guam, including Military Treatment Facilities, at the in-network benefit rate. FSBP has over 300 Direct Billing Arrangements (DBA) with healthcare providers across the world, which simplifies the process of claiming reimbursements for overseas care.
One user who had FSBP when posted in Frankfurt praised the massage and acupuncture benefits, as well as the quick and easy reimbursement process. Another user who moved from BCBS to FSBP when they moved overseas found the costs to be very reasonable. For example, for an ambulance ride, ER visit, hospital stay, multiple tests, and follow-ups, their total out-of-pocket cost was only $1000.
FSBP is a great option for federal employees based overseas due to its worldwide coverage, reasonable costs, and extensive network of healthcare providers.
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Flexible Spending Account (FSA): save 30% on out-of-pocket medical expenses
Federal employees in the US can choose from a wide range of health plans, including Consumer-Driven and High Deductible plans, Fee-for-Service (FFS) plans, and Health Maintenance Organizations (HMO). The best plan for an individual may depend on factors such as cost, coverage, and in-network providers.
One option available to federal employees is to enroll in a Flexible Spending Account (FSA), which is a special account that allows users to pay for certain out-of-pocket health care costs. FSAs are tax-advantaged accounts, meaning that users do not pay taxes on the money they put into the account. As a result, FSAs can help users save an average of 30% on qualified medical expenses. For example, if you plan to contribute the IRS maximum to your FSA, you will have access to the entire amount on the first day of the plan year. This allows you to spend now and contribute later, taking advantage of the tax savings.
It is important to note that FSAs have certain restrictions. Firstly, there is a limit of $3,300 per year per employer. Secondly, you generally must use the money in your FSA within the plan year, as unused funds are usually forfeited to your employer at the end of the year. However, your employer may offer a grace period of up to 2 and a half extra months to use the money, or allow you to carry over up to $660 per year to the following year. Additionally, FSAs cannot be used for insurance premiums, but they can be used for deductibles, copayments, prescription medications, medical equipment, and other eligible expenses.
To use your FSA, you can submit a claim to your employer with proof of the medical expense and a statement that it hasn't been covered by your plan. You will then be reimbursed for your costs. You can also use your Benefits Card to pay for eligible expenses directly from your FSA.
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Frequently asked questions
The FEHB Program is the largest employer-sponsored health benefits program, currently covering nearly 8.3 million federal employees and dependents. Federal employees typically share the cost of their health plan premium with the government. Depending on the plan, employees may also have to pay deductibles, copayments, or coinsurance.
Some popular options include GEHA, GEHA HDHP, BCBS Basic, and Kaiser. The best plan for you will depend on factors such as cost, coverage, and in-network providers. For example, GEHA is a good option for those who are single and rarely visit the doctor, while BCBS Basic is better for those with families. Kaiser is a good option for those who don't anticipate frequent doctor visits, as it has low premiums and reasonable out-of-pocket maximums.
Federal employees can save money by switching to a less expensive plan, such as a High Deductible Health Plan (HDHP), and by signing up for a Flexible Spending Account (FSA) to save on predictable out-of-pocket medical expenses. Additionally, employees can consider their specific needs, such as whether they require vision or dental benefits, when choosing a plan to ensure they are getting the best value.
