Which plan should I pick?

December 9, 2010 2:28 PM

Which federal health plan should I choose? I just moved to DC for a non-postal federal job, and I have narrowed down my options to Blue Cross Standard, Blue Cross Basic, and GEHA.

In particular, does anyone know how strong each of these networks is in the DC area? For example, where would I find statistics about the percentage of area doctors in the PPO of each plan? (I don't have doctors in the area yet.)

I know Blue Cross Standard is the best bet, because it has a good national network and it covers out-of-network doctors (just at a lower rate). But it is also the most expensive, so I would prefer one of the other two plans if the networks are strong enough.

Also, here is some general info about me relevant to picking a plan: I am a male in my mid-20s, and I go to doctors more than the average 20-year-old. In the next year I anticipate going to a psychotherapist each week, a gastroenterologist a few times, and possibly a physical therapist and/or psychiatrist. I have 2 generic perscription drugs. But obviously all of this might change.

posted by hijol to Health & Fitness (9 answers total)

I picked BCBS Basic after reviewing different scenarios. Unless you have a chronic condition that requires tons of prescriptions and dozens of doctor visits per year, I think the Basic is the best bet because you know what your cost will be going into it (it's based on flat fees, not percentages like the Standard plan). Emergencies and accidents are basically the same under both plans... just a few hundred dollars difference for a hospital stay, for instance... but you save so much money with the basic plan that even if you pay out an extra $300 to a hospital for the stay, you're still paying less over the whole year.

I can't speak to the size of the BCBS network in DC, but it was fine when I lived in GA, NC, and CA.
posted by buckaroo_benzai at 3:11 PM on December 9, 2010

We are in our second year on GEHA and have been very happy with it, FWIW. I just checked their website, and the provider directory is embedded in their "member web services", which doesn't help you very much. If you'd like me to generate a list of DC-area doctors in their network, memail me.
posted by DrGail at 3:14 PM on December 9, 2010

I also have had GEHA for two years and have been pretty happy. Every doctor I have wanted to see has been in network and they promptly reimburse me for visits to my out of network therapist with no fuss. This almost certainly does not apply to you, but they covered my breast reduction surgery without requiring any visits to specialists or jumping through hoops. That's pretty awesome and not the usual way that insurance companies handle that surgery. So all in all, yay GEHA.
posted by fancypants at 3:30 PM on December 9, 2010

We've had BCBS basic family for about 3 years now, and have had no problem finding preferred providers, even when on vacation. Even with a family of four (all pretty healthy, granted), we save more than enough on premiums to offset any increased out-of-pocket expenses compared to the standard plan. The only thing we have had a problem with is my wife's previous (flaky) dentist, who forgot to submit her paperwork one year to BCBS to remain a preferred provider, but failed to tell us that.

It won't give you the percentage you're looking for, but by doing a search here, I think you'll find a very large number of preferred providers close to just about any address in the US.

Also, the postal/non-postal pricing scheme cracks me up every year. Can I lower my premiums by going postal on my co-workers? (Please note, I did not just threaten to go postal on my co-workers.)
posted by partylarry at 3:31 PM on December 9, 2010

I know you asked about the DC area but I thought I would throw my 2-cents in. I have BC Standard. I liked the fact that I could go to any doctor without worrying whether they were in my network. I have a co-worker who has BC Basic and had when he needed to see a psychologist he had a difficult time finding one near his house because he was limited to who was in his plan.
posted by govtdrone at 5:09 PM on December 9, 2010

Consider the cheaper BCBS plan. (I wish they named them something more distinguishing than "basic" and "standard"!) The only thing the more expensive one gets you is going out of network. But the out of network reimbursements are so low anyway that it might not be worth it, especially when you add in the deductible you have to pay with the more expensive plan. You may be better off if you pick the cheaper plan and put aside funds in your FSA to cover psychotherapy (which is inevitably out of network).
posted by yarly at 5:29 PM on December 9, 2010

Response by poster: Opps I was logged into my friends account:

Thanks for the responses so far!

I thought going out of network to see a therapist would be ridiculously expensive. Seeing an out-of-network specialist might be more expensive per visit, but you might only see them a few times a year. I expect to see a therapist almost every week during the coming year.

fancypants: How much did the out-of-network therapist cost you each week?

yarly: What makes you say psychotherapy is inevitably out of network? If you have experience with going to a therapist and not using insurance, how much did it cost per week?

Anyone else: Any input on these questions?
posted by hijol at 6:38 PM on December 9, 2010

The out of network therapist charges $140 a session of which i get $91 reimbursed by GEHA. I see her only every other week or so so it's not an outrageous financial burden on me, though of course YMMV. They have a huge list of in network therapists (which I'd be happy to share if you need it) but for various reasons I needed to stick with who I was seeing.
posted by fancypants at 7:35 PM on December 9, 2010

There is a federal website that helps you choose plans. You answer some questions and it ranks the plans for you, with links to how happy people are with them.

This is how I ended up with a high deductible plan from Coventry, which I'm very happy with. Ordinarily, I would never have considered it, but the numbers added up. No referrals was just icing on the cake.
posted by QIbHom at 8:13 AM on December 10, 2010