FEHB HDHP options for Federal Employees

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grenada
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FEHB HDHP options for Federal Employees

Post by grenada » Mon Nov 05, 2018 8:14 pm

I'd like to make the jump onto the HDHP bandwagon during this upcoming open season, and would like to gather boglehead opinions and feedback on the various HDHP plans. I have a young family, my wife and I are healthy, and we have a healthy baby that is about 7 months old. We currently have BCBS Standard, and have been happy with it, but we certainly feel like we are overpaying by a whole lot for out of network coverage that we do not need. We live in Arlington, VA and it seems like all of our healthcare providers take the major FEHB plans.

I've read many of the past boglehead threads on FEHB plans, and it seems like the consensus has been that GEHA has historically been the best financial option, but not without some headaches due to some sloppy billing practices on the part of GEHA. The other thing that worries me about GEHA is that their summary of benefits has "Requires pre-approval" next to a lot of services. That makes sense for surgical procedures that are planned, but I was a little thrown off when I saw that language next to air ambulances for emergency transportation. Who calls your insurance to get approval when it is a life or death situation?

Aetna is certainly more expensive, but is a PPO and seems to have much better coverage - even better than BCBS Basic in many cases. So I'm between GEHA and Aetna - would appreciate any feedback on these two, as well as feedback on any of the others that are below. Checkbook.org will release their open season analysis on November 12th which I am looking forward to.
  • FEHB HDHP Options
  • GEHA - HDHP (34) FFS
  • Aetna HealthFund HDHP and Aetna Direct Plan - HDHP (22) PPO
  • CareFirst BlueChoice - HDHP (B6) HMO
  • UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) - HDHP (V4) HMO
  • MHBP - Consumer Option - HDHP (48) FFS

motorcyclesarecool
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FEHB Open Season HDHP shopping: Stay with GEHA or switch to MHBP?

Post by motorcyclesarecool » Mon Nov 05, 2018 9:12 pm

[Thread merged into here, see below. --admin LadyGeek]

It’s almost Civilian Federal Employee health insurance open season, and there have been some changes!

We are happy on HDHP and max our HSA every year.

This year, OPM has changed the limit on how much of the premium can be contributed by the plan to my HSA. Where last year GEHA kicked $1500 into my HSA (family enrollment), this year they will pass through $1800 to my HSA. The annual premium is $3787.42. Total cost to max my HSA for 2019: $8987.42

Mail Handlers got very creative with the new OPM limits. They’ll kick in $2400 to my HSA, and the annual premium is $3917.68. Total cost to max my HSA: $8517.68 The catch? $4000 deductible vs. $3000 with GEHA. Both plans use Aetna network. Mail Handlers uses PayFlex HSA.

Right now I’m leaning toward switching to Mail Handlers, but is there some flaw in my analysis or factor I haven’t considered?

It appears that PayFlex has access to Vanguard mutual fund Admiral Shares, which should be easier to deal with than the ETF offerings through HSABank/TDAmeritrade. Thoughts?
Last edited by motorcyclesarecool on Tue Nov 06, 2018 7:16 am, edited 1 time in total.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.

tigermilk
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Re: FEHB HDHP options for Federal Employees

Post by tigermilk » Mon Nov 05, 2018 9:13 pm

Have GEHA and have been happy with it, We have used it a couple of times. For 3 of the years the necessary medical work was under the deductible, so I never worried about pre-approval. This past July I crashed on my bike requiring a trip to the emergency room. I made sure the hospital was in network. The hospital staff didn't feel comfortable with the necessary treatment (lip through lacerations requiring stitches inside and out, slight next fracture) so I got shipped by ambulance to their main location. I didn't have to call, and I assume the hospital was doing all the right moves. My biggest issue through it all was simply the hospital or doctors not charging to the right company. In the end that was all straightened up. I did hit my deductible limit for the year, a d fortunately everything has been in network. The upcoming challenge will be with some dental work associated with the accident. I don't have the dental coverage but the HDHP does cover some maxillofscial surgery.

So far, in the 5 or 6 years of having it, it has saved us quite bit.

nps
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Re: FEHB Open Season HDHP shopping: Stay with GEHA or switch to MHPB?

Post by nps » Tue Nov 06, 2018 6:32 am

I also looked at this recently. When I compared and factored in the loss of preventive dental coverage, routine eye exams and glasses/contacts reimbursements, and health incentives, the MHBP increase in premium pass through over GEHA wouldn't be worth it for my family circumstances. If you take advantage of these it's something to consider.

Seal the Deal
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Re: FEHB HDHP options for Federal Employees

Post by Seal the Deal » Tue Nov 06, 2018 6:52 am

Have used GEHA for 7 years (HDHP last 2 years) with no real complaints. Definitely a big premium savings over BCBS. In 2018 GEHA changed their PPO network to UnitedHealthcare options in my area which provides a larger network than the previous company they used. It seems more in line with the BCBS network now. Some labs that weren't in network before are now.

No unusual billing practices that I've run into. Customer service has been helpful. The only pre-approval we did was for maternity. Had to use an ambulance once and didn't pre-certify (lol) and this was covered 100% along with resulting hospital bill under accidental injury coverage (this was under the standard plan; HDHP doesn't have 100% accidental injury coverage for ER).

The only sub-optimal coverage I've seen is for chiropractic which only covers $25/visit up to 12x/year.

Preventative dental benefits are quite good for health insurance. Each covered person gets 2 cleanings and 1 x-ray per year for no charge. And no networks for dental.

To get the max benefit of the HSA try to contribute the max for 2019. GEHA contributes $1800 to your HSA, so you should plan add $5200 through payroll deduction to reach the $7k max for 2019.

motorcyclesarecool
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Re: FEHB Open Season HDHP shopping: Stay with GEHA or switch to MHBP?

Post by motorcyclesarecool » Tue Nov 06, 2018 7:20 am

MHBP appears to have health incentives, at least. We expect to purchase extra dental coverage in 2019 through BENEFEDS regardless. I was very pleasantly surprised at how good the basic dental coverage was under GEHA. Definitely something to consider...
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.

Kaufmanrider
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Re: FEHB Open Season HDHP shopping: Stay with GEHA or switch to MHBP?

Post by Kaufmanrider » Tue Nov 06, 2018 8:33 am

GEHA does have Health Incentives and I always take advantage of them. :happy

https://www.geha.com/savings/health-rewards

I have been researching the Mail Handlers Consumer Driven HDHP Plan as it does interest me, however, do they provide the Health Incentive "money" to the HDHP?

The website states: "MHBP Standard Option and Value Plan members can earn Wellness Fund account rewards for completing a Health Risk Assessment and a Biometric Screening." No mention of the Consumer Driven HDHP.

The plan brochure for the Standard and Value plan specifically lists dollar amounts for Health Incentives whereas the HDHP brochure does not, except for a Diabetes Management Incentive that is not applied until 2020 calendar year.
Last edited by Kaufmanrider on Thu Nov 08, 2018 3:44 pm, edited 1 time in total.

InvisibleAerobar
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Re: FEHB HDHP options for Federal Employees

Post by InvisibleAerobar » Tue Nov 06, 2018 12:03 pm

Seal the Deal wrote:
Tue Nov 06, 2018 6:52 am
Have used GEHA for 7 years (HDHP last 2 years) with no real complaints. Definitely a big premium savings over BCBS. In 2018 GEHA changed their PPO network to UnitedHealthcare options in my area which provides a larger network than the previous company they used. It seems more in line with the BCBS network now. Some labs that weren't in network before are now.

No unusual billing practices that I've run into. Customer service has been helpful. The only pre-approval we did was for maternity. Had to use an ambulance once and didn't pre-certify (lol) and this was covered 100% along with resulting hospital bill under accidental injury coverage (this was under the standard plan; HDHP doesn't have 100% accidental injury coverage for ER).

The only sub-optimal coverage I've seen is for chiropractic which only covers $25/visit up to 12x/year.

Preventative dental benefits are quite good for health insurance. Each covered person gets 2 cleanings and 1 x-ray per year for no charge. And no networks for dental.

To get the max benefit of the HSA try to contribute the max for 2019. GEHA contributes $1800 to your HSA, so you should plan add $5200 through payroll deduction to reach the $7k max for 2019.
could you clarify that a bit? doesn't have 100% accidental injury coverage as in no out-of-network coverage, or doesn't have 100% coverage as in the policy holder is on the hook up to the annual maximum?

UpperNwGuy
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Re: FEHB HDHP options for Federal Employees

Post by UpperNwGuy » Tue Nov 06, 2018 12:44 pm

grenada wrote:
Mon Nov 05, 2018 8:14 pm
I'd like to make the jump onto the HDHP bandwagon during this upcoming open season, and would like to gather boglehead opinions and feedback on the various HDHP plans. I have a young family, my wife and I are healthy, and we have a healthy baby that is about 7 months old. We currently have BCBS Standard, and have been happy with it, but we certainly feel like we are overpaying by a whole lot for out of network coverage that we do not need. We live in Arlington, VA and it seems like all of our healthcare providers take the major FEHB plans.
Blue Cross Blue Shield Standard Option is the best program offered by the Federal Employee Health Benefits program, and that's why it is the most popular. Sounds to me like you plan to underinsure your little family to save a few bucks. I used to think that way, too, until my perfectly healthy young wife needed emergency surgery and then two years later my healthy second child needed surgery at six months of age and caught a serious disease at ten months of age requiring a week in the hospital. I think you owe it to your wife and child not to underinsure them.

Meanwhile, what does the statement I have highlighted in red mean?

Seal the Deal
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Re: FEHB HDHP options for Federal Employees

Post by Seal the Deal » Tue Nov 06, 2018 1:15 pm

InvisibleAerobar wrote:
Tue Nov 06, 2018 12:03 pm
Seal the Deal wrote:
Tue Nov 06, 2018 6:52 am
Have used GEHA for 7 years (HDHP last 2 years) with no real complaints. Definitely a big premium savings over BCBS. In 2018 GEHA changed their PPO network to UnitedHealthcare options in my area which provides a larger network than the previous company they used. It seems more in line with the BCBS network now. Some labs that weren't in network before are now.

No unusual billing practices that I've run into. Customer service has been helpful. The only pre-approval we did was for maternity. Had to use an ambulance once and didn't pre-certify (lol) and this was covered 100% along with resulting hospital bill under accidental injury coverage (this was under the standard plan; HDHP doesn't have 100% accidental injury coverage for ER).

The only sub-optimal coverage I've seen is for chiropractic which only covers $25/visit up to 12x/year.

Preventative dental benefits are quite good for health insurance. Each covered person gets 2 cleanings and 1 x-ray per year for no charge. And no networks for dental.

To get the max benefit of the HSA try to contribute the max for 2019. GEHA contributes $1800 to your HSA, so you should plan add $5200 through payroll deduction to reach the $7k max for 2019.
could you clarify that a bit? doesn't have 100% accidental injury coverage as in no out-of-network coverage, or doesn't have 100% coverage as in the policy holder is on the hook up to the annual maximum?
Yeah that wasn't worded too clearly. Under GEHA's standard plan for emergency care within 72 hours of an accident there is no copay, no deductible, everything is covered by insurance. For the HDHP the $3k deductible applies, then 5% coinsurance.

https://www.geha.com/docs/default-sour ... -guide.pdf

gclancer
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Re: FEHB HDHP options for Federal Employees

Post by gclancer » Tue Nov 06, 2018 3:04 pm

UpperNwGuy wrote:
Tue Nov 06, 2018 12:44 pm
Sounds to me like you plan to underinsure your little family to save a few bucks.
You make it sound as if underinsuring = not receiving needed care. If OP has $10k to his name that would likly be sufficient to cover the annual catastrophic limit under all FEHB HDHP plans I’m aware of. After 2 years OP could have enough in his HSA to cover the annual catastrophic limits such that he would have a dedicated savings account sufficient to meet any potential future medical costs.

Perhaps you’re suggesting that the quality or providers within BCBS’ network are better than other networks, but my experience has been that the doctors I go to pretty much accept all networks.

Super Hans
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Re: FEHB HDHP options for Federal Employees

Post by Super Hans » Tue Nov 06, 2018 4:11 pm

UpperNwGuy wrote:
Tue Nov 06, 2018 12:44 pm
Sounds to me like you plan to underinsure your little family to save a few bucks.
I'm also puzzled by this comment. I don't understand how I'm underinsuring through my choice of the GEHA HDHP over Blue Cross. I pay lower premiums, but I'm not aware of any network advantage with BC/BS. In fact, we have one doctor who only takes UHC, curiously, so we'd be in worse shape with Blue Cross. Of course, we get nice tax savings from the HSA contribution and free routine dental care, too.

:confused

Golf maniac
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Re: FEHB HDHP options for Federal Employees

Post by Golf maniac » Tue Nov 06, 2018 4:21 pm

I went away from BCBS years ago. The coverage for the price was just not that good. We are retired so more use of insurance so we have gone with NALC high option for a while. It is the best cost for the coverage we need. Cigna runs it and we have had no issues with claims and all our doctors take it.

For OP, look at coverage and cost and determine what you need. Remember you can change the next year if you don’t like the coverage.

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LadyGeek
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Re: FEHB HDHP options for Federal Employees

Post by LadyGeek » Tue Nov 06, 2018 4:23 pm

I merged motorcyclesarecool's thread into a similar discussion.
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TimeRunner
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Re: FEHB HDHP options for Federal Employees

Post by TimeRunner » Tue Nov 06, 2018 4:38 pm

In case you haven't seen it, here's the link to OPMs Healthcare comparison tool for 2019 plans, which is a good starting place for looking at options:
https://www.opm.gov/healthcare-insuranc ... are-plans/
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Helo80
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Re: FEHB HDHP options for Federal Employees

Post by Helo80 » Wed Nov 07, 2018 4:28 pm

In the same boat as several of y'all, and I'm very interested in MHBP due to the use of Payflex over HSA Bank. Nothing against HSA Bank, but I have used Payflex for years and while the interface is a bit "hello 2005" it is wonderful once you get the hang of it, and I can set and forget VFIAX investments.

Helo80
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Re: FEHB Open Season HDHP shopping: Stay with GEHA or switch to MHBP?

Post by Helo80 » Thu Nov 08, 2018 6:41 pm

motorcyclesarecool wrote:
Mon Nov 05, 2018 9:12 pm
Mail Handlers got very creative with the new OPM limits. They’ll kick in $2400 to my HSA, and the annual premium is $3917.68. Total cost to max my HSA: $8517.68 The catch? $4000 deductible vs. $3000 with GEHA. Both plans use Aetna network. Mail Handlers uses PayFlex HSA.

Right now I’m leaning toward switching to Mail Handlers, but is there some flaw in my analysis or factor I haven’t considered?

I was looking closer a the MHBP plan today. On the first page of the plan information PDF https://www.opm.gov/healthcare-insuranc ... 71-016.pdf
  • Who may enroll in this Plan: All Federal employees and annuitants
    who are eligible to enroll in the Federal Employees Health Benefits
    Program and who are, or become, members or associate members of
    the National Postal Mail Handlers Union, AFL-CIO, a division of
    LIUNA.

    To become a member or associate member: If you are a non-postal employee or an annuitant, you will automatically
    become an associate member of the National Postal Mail Handlers Union upon enrollment in MHBP.
    There is no
    membership charge for members of the National Postal Mail Handlers Union, AFL-CIO, a division of LIUNA.

    Membership dues: $42 per year for an associate membership except where exempt by law. New associate members will
    be billed by the National Postal Mail Handlers Union for annual dues when the Plan receives notice of enrollment.
    Continuing associate members will be billed by the National Postal Mail Handlers Union for the annual membership.



So, I would imagine most federal employees here are not postal handlers. While the MHBP HDHP plan may be open to us, we would be expected to pay the $42 fee in the NPMH Union fee.

motorcyclesarecool
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Re: FEHB HDHP options for Federal Employees

Post by motorcyclesarecool » Thu Nov 08, 2018 6:52 pm

Yes. I did it before when I signed up for the NALC (National Association of Letter Carriers) plan for pregnancy #1. Piece of cake.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.

Tdubs
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Re: FEHB HDHP options for Federal Employees

Post by Tdubs » Thu Nov 08, 2018 7:02 pm

Can someone clarify when the HSA would actually be "set up." OPM says medical expenses are only reimbursable after the HSA is set up. The GEHA pass through contribution would not be available until February 15, but I assume if I am contributing to my HSA the account will be set up when I start deducting voluntary contributions from my paycheck, which would be the first pay period of 2019, right? Or do I basically wait for a month and a half to go to the doctor or the emergency room?

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BogleFanGal
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Re: FEHB HDHP options for Federal Employees

Post by BogleFanGal » Thu Nov 08, 2018 7:13 pm

Had Aetna HDHP for 9 years, then switched to GEHA HDHP in 2018 after reading some comments and opinions on a similar thread last year. Neither is bad in my opinion.

Noticed Aetna responds faster to questions than GEHA. Aetna = Payflex for saving/investing dollars and that gets you Vanguard funds without commission. Hated losing that when I switched.

But I like that GEHA is nonprofit, premiums are lower and we have a 5% copay vs Aetna's 10% after meeting deductible, unless that's changed. (Although Aetna's total out of pocket was a couple thousand lower than GEHA, at least as of last year.)

Both have wellness incentives - but Aetna's rewards you in cash deposited to your HSA account. GEHA's incentives are essentially credits that can only be used to purchase items in their online stores or CVS mail order RX. But you can earn double at GEHA what you can at Aetna - $150/total pp vs $75/total pp.

I know nothing about mail handlers...but after just switching last year - new plan, new HSA, new paperwork, feeling a little too lazy to do it all again unless MH offers something substantially better. So following this thread with interest.

motorcyclesarecool
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Re: FEHB HDHP options for Federal Employees

Post by motorcyclesarecool » Thu Nov 08, 2018 7:20 pm

1. OPM indicates that
The effective date of the Open Season change is the first day of the first full pay period in January. For annuitants this date will always be January 1
2. Call the plan administrator to find out how / when they establish the HSA.

My conversation with the person who answered the phone at MHBP (who seemed none too certain) indicated that the HSA account should be open by February. Any expenses incurred before establishing the HSA will at least count toward the deductible.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.

Helo80
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Re: FEHB HDHP options for Federal Employees

Post by Helo80 » Thu Nov 08, 2018 9:17 pm

Tdubs wrote:
Thu Nov 08, 2018 7:02 pm
Can someone clarify when the HSA would actually be "set up." OPM says medical expenses are only reimbursable after the HSA is set up. The GEHA pass through contribution would not be available until February 15, but I assume if I am contributing to my HSA the account will be set up when I start deducting voluntary contributions from my paycheck, which would be the first pay period of 2019, right? Or do I basically wait for a month and a half to go to the doctor or the emergency room?
Not sure how your agency is setup, but for me, I fill out a PDF form that I email to payroll. That form has my voluntary deduction amount, as well as, my Payflex account number. So, I don't know how payroll can possibly make a voluntary deduction without an associated account number to send the money to.

I believe that HSA's freely permit one writing a check and contributing to HSA's that way. Though, payroll deduction is obviously much simpler.

Kaufmanrider
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Re: FEHB HDHP options for Federal Employees

Post by Kaufmanrider » Sat Nov 10, 2018 12:40 pm

Tdubs wrote:
Thu Nov 08, 2018 7:02 pm
Can someone clarify when the HSA would actually be "set up." OPM says medical expenses are only reimbursable after the HSA is set up. The GEHA pass through contribution would not be available until February 15, but I assume if I am contributing to my HSA the account will be set up when I start deducting voluntary contributions from my paycheck, which would be the first pay period of 2019, right? Or do I basically wait for a month and a half to go to the doctor or the emergency room?

I am retired and started the GEHA HDHP in January of this year. I was able to open my HSABank account early in January and transfer my own funds into it within a couple of days after opening. It took a few days for the mini deposits of a few pennies to be made by HSABank into my accounts to verify them.


I am intersted in Mail Handlers and I found a HSA Comparison calculator. https://www.comparemyhsa.com/consumer/comparison

If I have minimal medical costs Mail Handlers is about 600 less then GEHA. But if I factor in dental cleanings GEHA covers for myself, spouse and daughter, GEHA is better. If I opt for supplemental dental though next year Mail Handlers would be better.

However, If I have high medical costs, i.e., like a surgery, which seems likely next year GEHA is best due to the lower deductible and out of pocket max per person which are both $1000 less then Mail Handlers.

I'm glad I have about a month to decide what I am going to do. :happy

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