Miscellaneous

I'm not very healthy and could easily have expenses of many thousands of dollars next year. So I don't think that your rankings based on average costs are what I should use. What should I do?

A good method is to skip the average column and look at the column for high expenses of $30,000. Within that column, choose among several plans that our comparisons indicate are relatively low-cost. Another approach is to compare catastrophic limits. But keep in mind that our "average" columns include some very expensive years.

Skip all the details. What is the best plan?

There is no one best plan. Every plan is best for at least some people. Our rankings give you a good starting point, but only a starting point. If you don't want to be bothered with details, then check out only one or two plans carefully. But whatever else you do, read the "how we change" pages of the brochure, along with the summary of benefits before you stay in the plan you are in or sign up for a new plan.

I work in Washington DC. I have daughters aged 18 and 22. One will be in college in New York State, the other in grad school in another state. I need a plan where my daughters can get treatment where they live.

There are about 30 plans open to employees working in the DC metro area (and almost as many in most other cities). Over two-thirds of them will cover your family members no matter where they live, so you will have no trouble covering your daughters, whatever their choices. Our plan flexibility ratings indicate which plans have network providers and plan coverage nationwide.

I really like the service from plan X. But it is rated halfway down your cost table. Would I be a sucker to stay with it?

No. Differences of several hundred dollars in estimated costs can move a plan up or down the table a long way. Our methods of estimating average costs are only approximations. Differences of $100 or less are not significant, and a national plan even halfway down the table is a perfectly acceptable deal. Furthermore, staying with the same plan will eliminate the hassle of changing doctors and of dealing with a plan that may not be as customer friendly as the one you have now.

My son is 21 years old and disabled, I just got him on Medicaid, do I still need to carry him under my insurance too?

We do not give legal advice. But we guess that there is probably no legal requirement that you enroll in health insurance that covers your son. You may, however, wish to consult Medicaid officials in your state to be safe. Under the PSHB program, moreover, you can cover a severely disabled child under your policy even after he turns age 26, and this eligibility can even follow your death. This is a valuable benefit and it is well worth getting a self plus one enrollment to protect your son. Also, only about half of all doctors participate in Medicaid and your PSHB plan will give him broader provider access.

I understand that I have to be enrolled in PSHB continuously for five years before retirement. Can I change plans during those five years?

You can change plans in every open season before and after you retire with no fear. The five year rule is for enrollment in any plan in the program, NOT one plan.

My 18-year old daughter is unemployed and has been told she is eligible for Medicaid. She is healthy. Should she enroll?

Yes, she should enroll in Medicaid if she is eligible in your state. This will protect her if some sudden illness or accident befalls her. You could also cover her at no extra cost under your PSHB plan if you are in a family enrollment. This will give her good coverage until she reaches age 26. But in Medicaid her share of costs will be close to zero. So that is a good option until she lands a job.

We are moving to SC from WV. My husband is a retired rural letter carrier. The plan he has now is not available in SC.

Your move is considered a significant life event that will allow you to choose a new plan. You can choose any plan that serves the area where you are moving. There are over twenty plans open to you. We suggest you simply use our Guide with the new South Carolina zip code to see the available plans and which ones have the cost, coverage, and quality you want.

I am trying to figure out what kind of health care to get for me and my family. There so many kinds and I don't know what to pick. I do not know anything or how to pick a health plan, dental or vision care.

We recommend that you use the Guide to help you choose a plan. Please read the sections on how the program works. They will help you understand the rest. Answer a few simple questions and it will take you to results showing which plans are good buys for you and your family. We also have information on dental and vision FEDVIP plans. You might also talk to a few co-workers and see what they advise. They already use these plans and probably have a pretty good idea of what you should look for. But be sure not to join a plan that is very expensive just because coworkers are enrolled in it.

You rated the plan I am in highly last year, but this year it has moved way down. Why did this happen and should I switch?

Premium differences are the biggest factor in our cost rankings, and premiums can swing widely from year to year. That is probably why your plan moved so far-but check the brochure's change page for a benefit cutback that could have affected our ratings. Or other plans could have improved their benefits. One of the big change factors, for example, is the catastrophic limit promised to you by the plan: these often move up or down by thousands of dollars and are big factors in our ratings. You can stick with your plan if it has not become unreasonably costly and has given you good service. But consider the possible savings from the plans we rank higher.

Some expensive plans have much better quality scores than some less expensive plans. How much weight should I put on quality?

The quality scores are driven by survey results from enrollees in each plan. Our ratings also show some of the factors those enrollees most like or dislike. Only you can judge how important these are to you. It may help to consider two things: most enrollees in just about all plans rate the plans quite favorably; and ultimately it is the doctors you choose, not the plan, that drives the quality of medical care you get. Also, younger enrollees tend to be more critical of their plans than older enrollees. Since HMOs and High Deductible plans get disproportionate numbers of younger enrollees, this may explain some of the differences.