Comparing Federal Government Plans: Rates vs. Percentages? BCBS vs. Carefirst?
I am a recently-hired US Federal Government employee living in the Washington DC area. I am reviewing health plans before signing up, and I think I have boiled it down to one of these two. I am a 40-ish male with a family history of heart disease. I do not live a sedentary life, but I do work at a desk 9 hours a day, so maybe I do? I go to Orange Theory, aim for 10K steps a day, don't smoke or do drugs, don't drink that much, and a have a decent "Mediterranean" focused diet with minimal animal proteins.
I have been a long time (and very happy) customer of Carefirst BCBS.
All of my "most important" doctors are IN-NETWORK for either plan.
The two plans I am considering:
BCBS FEHB Standard Plan: $284/month. PPO with In- and Out-of-Network coverage.
Carefirst BlueChoice Standard Plan: $424/month HMO with In- and Out-of-Network coverage.
I will refer to these as "BCBS" and "Carefirst," respectively.
Since it is difficult to compare these, even with the archaic comparison tool offered by OPM, I made my own Excel spreadsheet. They of course make it difficult to do apples-apples comparisons.
If pick one line-item, IN-NETWORK "Emergency & Urgent Care – Emergency Care" then the BCBS FEHB plan costs "15%" versus "$200" for the Carefirst HMO. I would assume here that the flat fee of $200 is the "better" benefit, correct? I mean if the total bill comes to $10,000 then $200 is a heck of a lot cheaper than 15% of that or $1500! Or are they talking 15% up until the annual $350 deductible of the BCBS plan? I mean a $10K "Emergency" care visit is most definitely in the realm of possibility these days, so why would anyone prefer a "percentage benefit" versus a flat fee?
It should be ILLEGAL that they make this all so fvcking difficult!
My logic is to drill down the list of benefits to the MOST EXPENSIVE item ("inpatient surgery") and then compare benefits. Does that make sense? That's why we have insurance! Back to our two plans above, looking at IN-NETWORK "Surgery & Hospital Charges – Hospital Inpatient Cost Per Admission" the BCBS plan comes out to a fee of $350 versus the Carefirst HMO, which costs "20%." In this example, the BCBS plan seems clearly better, right?
Finally, the federal government comparison tool gives the BCBS plan an overall "very good" rating versus "excellent" for the Carefirst plan.
Which is the "better" plan here?
Thanks for any help you can provide.
submitted by /u/DC-DE
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