Do they have benefit caps? Considering that we all pay for their coverage if government employees faced the same problems with insurance the rest of us do would those problems have been corrected before they even existed?
--------------------
Good question and the system doesn't work like people believe it does (especially when Hillary talks about the "same care Congress has" in her plan). There are choices. Here's the link for 2008 so you can see for yourself: http://www.opm.gov/insure/health/ There is no one company that ensures them. Employees are given a "menu" that applies to their paygrade, location, etc. and they offer from HMOs to FFS (Fee For Service--the traditional plan that most people still think of with insurance). I suspect they have caps, but there is no way I'm going to read through every possible plan to find out--plus insurers are notorious for making it hard to find that info--until it's too late. They do have companies with LOW satisfaction scores. For grins, I selected 4 plans for MY zip code and found that some had just over 50% and less than 60% overall plan satisfaction. Such a deal, eh? Looks like a ballpark guess is that the government picks up about 70% of the cost of the plan and the employee about 30%. As with everyone else's plan when they do talk about out-of-pocket max's they always say things like co-pays and some things do NOT count toward the out-of-pocket AND after you hit your max, you still pay the co-pays. I think what we have to remember is that HIGH PROFILE folks in government will get anything they want--even if it's not technically covered I'm sure they can get taken care of. For your poor DMV clerk or something, he's probably as bad off as the cashier at the grocery store. THE FOLLOWING IS FROM 2002 SO IT IS OLD, BUT INTERESTING: "www.tscl.org Ask the Advisor: Congressional Health Care Benefits, the Rolls Royce of Health Plans? Why not scrap Medicare in favor of something better? I refer to the cost-effective health plan enjoyed by all of Congress. I understand it includes prescription drugs. I've asked my Congressman, Joe Hoeffel (D-PA) to spell out what's in his health plan, what he pays and how it is funded. He has ignored my requests. I've heard it referred to as the Rolls Royce health care plan. This seems like a good idea for everybody instead of trying to fix the damn-near broke Medicare.-T.M, Plymouth Meeting, PA From the editor: Members of Congress enjoy excellent health benefits under the Federal Employees Health Benefits Program (FEHBP). For 2002, Representative Hoeffel could choose from 11 different health care plans under FEHBP. All plans offer prescription drug benefits. The government (meaning taxpayers like you and me) pays 72% of the average premium but not more than 75%. Your Congressman saw the remaining 25% deducted from his $12,500 monthly paycheck (also paid for by you and me). This is similar to the amount the government pays under Medicare. Under Medicare, the government pays 75% of the Part B premium and the other 25% monthly premium is deducted from your Social Security check (which is much, much less than $12,500 per month). Among the 11 health plans, the federal employee share of monthly premiums ranges from a low of $55.58 per month to a high of $354.08 per month. These premiums compare with Medicare Part A hospital insurance and Medicare Part B doctors' and outpatient services. But, they also include prescription drug coverage. Medicare Part B premiums in 2002 are $54 per month. Most Medicare beneficiaries pay nothing for Medicare Part A, but most supplement Medicare, and pay additional premiums for Medigap policies. The Medicare deductibles in 2002 are $812 for Part A and $100 for Part B. FEHBP deductibles range from nothing for hospital stays to $500. Doctor and outpatient services deductibles range from none to $500. Prescription drug deductibles range from none to $600. The plan with the lowest combination of deductibles is $250; the plan with the highest is $1,150. There is no Medicare Part A hospital co-insurance for the first 60 days. After that Medicare beneficiaries pay $203 per day for the 61st to 90th day in each period and $406 a day for the 91st to 150th day. Hospital inpatient co-insurance in FEHBP ranges from nothing to 35%. Medicare Part B coinsurance is generally about 20%. Under FEHBP the coinsurance ranges from 10% to as much as 35%. FEHBP drug insurance co-insurance varies depending upon whether the prescription is generic, brand name or a non-formulary drug. Copayments start as low as $5 but co-insurance can be as high as 50% depending on the plan and the type of drug. In 2000, the National Bipartisan Commission on the Future of Medicare ended with no agreement on a proposal to reform Medicare along lines similar to the FEHBP plans. The so-called "premium support" model would essentially privatize Medicare leaving the government in the role of negotiating contracts with participating health plans as they do for the FEHBP plans. Senator John Breaux (D-LA) introduced legislation in 2001 to reform Medicare along these lines but it remains in committee. Even under such a system, the biggest problem for Medicare remains the financing. FEHBP plans aren't necessarily that much more cost-efficient. FEHBP costs are rising by double-digit rates as well. Premiums rose in 2001 by an average of 13.3%. The Blue Cross standard option, popular with many retirees, rose by 20% for individual coverage. This increase was on top of a 2000 average increase of 10.5% and an increase of 21.2% in Blue Cross standard option. No matter which system, with increasing numbers of persons becoming eligible and health care costs continuing to climb, Medicare remains as you say, "damn-near broke." To read more about the FEHBP, you can download a free copy of the 2002 Federal Employees Health Benefits guides for working employees as well as retirees online at www.opm.gov/insure/health/index.htm. If you do not have internet access, ask your library for help. March 2002" http://www.tscl.org/NewContent/101421.as…
Source
No comments:
Post a Comment