FEHB: So Many Options to Choose From

FEHB Open Season is Here

The FEHB open season is upon us. Federal Employees and retirees have until December 8th to make changes to their health care coverage for the upcoming year.

FEHB Covers Many and Has Many Choices

According to OPM, the FEHB covers approximately 8.2 million people, and in 2015 there will be 257 different plans to choose from. Thankfully, most plans fall into one of two categories, Health Maintenance Organization (HMO) or Fee-For-Service (FFS).

HMO Plans

HMOs offer one-stop service when it comes to your health care needs. Each HMO has a list of doctors from which you can choose a primary care physician. This physician will act as your gatekeeper to the wider array of medical services available. Whether you have heart palpitations, a hangnail, or a persistent cough, your first stop is to the primary care physician, who will refer you to a specialist if he or she deems necessary. Many people are comfortable with these parameters, and find it convenient to leave those decisions up to their primary care doctor. No more hours spent hunting through outdated lists of doctors who take your insurance, only to be cut off by a semi-polite receptionist who says, “I’m sorry, Dr. So-and-So no longer works here.” or, “I’m sorry, we no longer take that insurance.”

FFS Plans

Still think you should be seen by a specialist after a third visit to your primary care physician for bloating leaves you with nothing but another diet suggestion? Well, if you have an FFS plan, you have the power to refer yourself to a gastroenterologist.

Most of the FEHB’s FFS plans use a Preferred Provider Organization (PPO). Using a doctor or other provider within the PPO network will typically lower your out-of-pocket expenses.

HMO vs. FFS:

So which is better, an HMO or FFS plan? That’s the $64,000 question. Some HMO plans are better than others, and some FFS plans are better than others. Some doctors are better than others and some patients take better care of themselves than others.

Making the Choice

If you haven’t already investigated your options, now is the time to do it. You have until December 8th to make your decision. Ask your colleagues, check the internet, get recommendations from a specialist or two. And take heart, if you don’t like the final choice you make, there’s always another open season next year.