Catastrophic Coverage Tips

Federal News Network columnist Mike Causey promoted Consumers Checkbook FEHB Open Season Guide in last Friday's column captioned Easy on the Brain Health Plan Tips. (The FEHBlog subscribes to this guide.)  Mr. Causey writes

[Th]e health insurance open enrollment season . . . runs through close-of-business Dec. 10 . . . . Here are three quick tips for health plan hunters from Walton Francis. He’s the guy who literally wrote the book, “Checkbook’s Guide to Health Plans For Federal Employees.” The book is available at many stores in the D.C. area while the online version is available courtesy of their agency to most employees at work.

• Catastrophic coverage is the most important feature of a health plan. How much will you be out of pocket if you suffer a major illness or accident next year?
• Would you like to be covered by a health plan that will give you a savings account that is more than the premiums you’ll pay?
• And finally, will shifting to the standard or basic option of your plan give you the same coverage at a much lower premium?

Bear in mind that under the Affordable Care Act ("ACA"), health plans must offer an in-network limit on member cost sharing for covered essential health benefits. For 2019, this ACA mandated catastrophic protection coverage may not exceed $7,900 for self only coverage and $15,800 for other than self and family coverage. Plans may and typically do provide higher limits for out-of-network care. Non-essential health benefits are excluded from all catastrophic coverage. 

So, don't just look for the best catastrophic coverage. Make sure your health care providers are in-network.  Your best bet to stay under the catastrophic protection limit is to have and use a primary care doctor that you trust. A primary care doctor who is in network is the best possible option because he or she will try to manage all of your care in-network.  An out of network primary care doctor can help you find specialist and hospital care that is in network. Your health plan can help you with that decision making process too. 

If you don't have a primary care doctor, use the health plan open season as an opportunity to find an in-network primary care doctor. Blue Cross offers five tips on finding a primary care doctor here.

Also with regard to the Consumer Checkbook's second tip. the FEHBlog has a high deductible plan with a health savings account (outside the FEHBP).  He thinks it's a great choice for people who are starting to think about retirement because health savings accounts are triple tax free -- deposits are made tax free; the account grows tax free, and the payments out of the account for tax deductible medical expenses are tax free. The best. Build up your health savings account in preparation for retirement. The right to contribute to Medicare ends once you become eligible for Medicare.