Comparing Federal Employee Health Insurance Plans: A Detailed Guide

Choosing the right health insurance plan is a critical decision for federal employees. With a variety of options available under the Federal Employees Health Benefits (FEHB) program, it’s essential to compare plans carefully to find one that best meets your individual and family needs. This guide provides a detailed comparison of several FEHB plans, focusing on key aspects such as costs, network, and coverage details to aid you in making an informed decision.

Understanding Your FEHB Options: A Comparative Overview

The FEHB program offers a wide array of health insurance plans, each with its own structure of benefits, costs, and provider networks. Understanding the differences between these plans is the first step in selecting the right coverage. This comparison focuses on High Deductible Health Plans (HDHPs), which are increasingly popular due to their lower premiums and the opportunity to save for healthcare expenses through Health Savings Accounts (HSAs).

Costs & Network: Key Financial Considerations

When Comparing Federal Employee Health Insurance Plans, cost is invariably a primary concern. It’s crucial to look beyond just the bi-weekly premium and consider the total potential out-of-pocket expenses, including deductibles and maximum out-of-pocket limits. Network accessibility is also vital, ensuring that your preferred doctors and hospitals are within the plan’s network to minimize costs and maximize coverage.

Plans Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Plan Links
General Information – State Alabama Alabama Alabama Alabama
General Information – Enrollment Code – Self 224 111 341 481
General Information – Enrollment Code – Self & Family 225 112 342 482
General Information – Enrollment Code – Self Plus One 226 113 343 483
General Information – Carrier Code 22 11 34 48
General Information – Telephone Number 877-459-6604 1-800-411-2583 800-821-6136 800-694-9901
Biweekly Premium $135.20 $113.16 $76.27 $84.20
Biweekly Premium $287.01 $274.14 $163.99 $186.33
Biweekly Premium $241.49 $303.61 $201.52 $195.65

Plan Networks and Deductibles: Navigating Coverage and Out-of-Pocket Costs

Understanding the network associated with each plan is crucial. In-network providers will always be more cost-effective, and HDHPs often have different deductibles for in-network and out-of-network services. Deductibles are the amount you pay out-of-pocket before your insurance starts to pay, so lower deductibles can be advantageous if you anticipate needing frequent medical care.

Plans – Networks Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) – In-Network Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) – Out-of-Network Blue Cross and Blue Shield Service Benefit Plan (Basic) – In-Network 1 Blue Cross and Blue Shield Service Benefit Plan (Basic) – In-Network 2 Blue Cross and Blue Shield Service Benefit Plan (Basic) – Out-of-Network GEHA Benefit Plan (HDHP) – In-Network 1 GEHA Benefit Plan (HDHP) – Out-of-Network MHBP Consumer Option (HDHP) – In-Network 1 MHBP Consumer Option (HDHP) – Out-of-Network
Annual Deductible $1,800.00 $2,600.00 None None None $1,650.00 $3,300.00 $2,000.00 $2,000.00
Annual Deductible $3,600.00 $5,200.00 None None None $3,300.00 $6,600.00 $4,000.00 $4,000.00
Annual Deductible $3,600.00 $5,200.00 None None None $3,300.00 $6,600.00 $4,000.00 $4,000.00
Type of Account HSA/HRA HSA/HRA None None None HSA/HRA/HRA HSA/HRA/HRA HSA/HRA/HRA HSA/HRA/HRA
Medical Account Contribution $800.00 $800.00 N/A N/A N/A $1,000.00 $1,000.00 $1,200.00 $1,200.00
Medical Account Contribution $1,600.00 $1,600.00 N/A N/A N/A $2,000.00 $2,000.00 $2,400.00 $2,400.00
Medical Account Contribution $1,600.00 $1,600.00 N/A N/A N/A $2,000.00 $2,000.00 $2,400.00 $2,400.00
Net Deductible $1,000.00 $1,800.00 None None None $650.00 $2,300.00 $800.00 $800.00
Net Deductible $2,000.00 $3,600.00 None None None $1,300.00 $4,600.00 $1,600.00 $1,600.00
Net Deductible $2,000.00 $3,600.00 None None None $1,300.00 $4,600.00 $1,600.00 $1,600.00
Annual Out-of-Pocket Maximum $6,900.00 $9,000.00 $7,500.00 None None $6,000.00 $8,500.00 $6,000.00 $7,500.00
Annual Out-of-Pocket Maximum $13,800.00 $18,000.00 $15,000.00 None None $12,000.00 $17,000.00 $12,000.00 $15,000.00
Annual Out-of-Pocket Maximum $13,800.00 $18,000.00 $15,000.00 None None $12,000.00 $17,000.00 $12,000.00 $15,000.00

Member Costs with Medicare: Coordinating Benefits

For federal employees who are also eligible for Medicare, understanding how FEHB plans coordinate with Medicare is essential. Some FEHB plans offer features like deductible waivers or out-of-pocket maximum adjustments when Medicare is primary, potentially reducing your healthcare costs significantly.

Member Cost with Medicare A & B Primary Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Deductible Waiver with Parts A & B $1800 $2600 N/A Deductible Waived
Out-of-Pocket Maximum with Parts A & B $6900 $9000 $7500 $15000 $6000 $12000
Primary Care Physician Office Visit with Medicare A & B Primary 15% Coinsurance 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Copayment Waived
Specialty Office Physician Visit with Parts A & B 15% Coinsurance 40% Coinsurance + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Coinsurance Waived
Inpatient Hospital Services with Parts A & B 15% Coinsurance 40% Coinsurance + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Coinsurance Waived
Outpatient Hospital Services with Parts A & B 15% Coinsurance 40% Coinsurance + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Coinsurance Waived
Part B Premium Reimbursement with Parts A & B No No $800 Max No

Member Costs with Medicare Advantage (Part C) Primary

If you are enrolled in a Medicare Advantage (Part C) plan, your FEHB plan will act as secondary coverage. Understanding the cost-sharing implications under these circumstances is important for budgeting healthcare expenses.

Member Cost with Medicare Advantage (Part C) Primary Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Deductible Waiver with Part C N/A N/A N/A N/A
Out-of-Pocket Maximum with Part C N/A N/A $7500 $15000 $6000
Primary Care Physician Office Visit with Medicare Advantage (Part C) Primary 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing $15 Copayment
Specialty Physician Office Visit with Part C 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing $15 Copayment
Inpatient Hospital Services with Part C 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing $75 Per Day Up To $750 Per Admission
Outpatient Hospital Services with Part C 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing $75 Copayment
Part B Premium Reimbursement with Part C N/A N/A No No

Prescription Drug Coverage and Costs with Medicare Part D EGWP

Prescription drug costs can be a significant portion of healthcare spending. For those with Medicare Part D Employer Group Waiver Plan (EGWP), it’s crucial to compare the drug formularies and cost-sharing structures of different FEHB plans, especially for maintenance medications.

Member Cost with Medicare Part D EGWP Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Prescription Drug Deductible N/A N/A N/A N/A
Out-of-Pocket Maximum N/A N/A $2000 $2000
EGWP Tier 0 N/A N/A N/A Member Pays Nothing
EGWP Tier 1 N/A N/A $10 $8
EGWP Tier 2 N/A N/A $45 Copayment $45
EGWP Tier 3 N/A N/A 50% $70
EGWP Tier 4 N/A N/A $75 Copayment 25%
EGWP Tier 5 N/A N/A N/A N/A
EGWP Tier 6 N/A N/A N/A N/A

Primary and Specialty Care: Access and Costs

Access to primary and specialty care is a fundamental aspect of any health insurance plan. Consider the copays or coinsurance for office visits, and whether referrals are required to see specialists. Preventive care is typically covered at no cost to the member in most plans, encouraging proactive health management.

Primary/Specialty Care Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Preventive Care Member Pays Nothing 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Member Pays Nothing
Primary Care Office Visit 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment $15 Copayment
Specialist Office Visit 15% 40% + Difference Between Plan Allowance and Billed Amount $50 Copayment $15 Copayment
Plan Requires Referral to See Certain Specialists No No No No

Emergency and Urgent Care: Costs for Unexpected Health Needs

It’s important to understand the costs associated with emergency and urgent care services. Plans may have different copays or coinsurance for emergency room visits versus urgent care centers. Some plans also waive out-of-pocket costs if you are admitted to the hospital following an ER visit, which can be a significant benefit.

Emergency & Urgent Care Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Emergency Care 15% 15% $0 Copayment + $350 $50 Copayment
Urgent Care 15% 40% + Difference Between Plan Allowance and Billed Amount $50 Copayment $50 Copayment
Out-of-Pocket Waived No No Yes Yes

Surgery and Hospital Charges: Understanding Inpatient and Outpatient Costs

Hospital stays and surgeries can be among the most expensive healthcare services. Comparing the costs for inpatient and outpatient surgery, hospital admissions, and related services like room and board is crucial, especially if you anticipate needing these services.

Surgery & Hospital Charges Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Doctor Costs Inpatient Surgery 15% 40% + Difference Between Plan Allowance and Billed Amount $200 Copayment Member Pays Nothing
Hospital Inpatient Cost Per Admission 15% 40% + Difference Between Plan Allowance and Billed Amount $350 Per Day Up To $1750 Per Admission $75 Per Day $750 Max
Room & Board Charges 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Member Pays Nothing
Other Inpatient Costs 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Member Pays Nothing
Doctor Costs Outpatient Surgery 15% 40% + Difference Between Plan Allowance and Billed Amount $150 Copayment Or $200 $150
Other Outpatient Costs 15% 40% + Difference Between Plan Allowance and Billed Amount $250 Per Day Or $350 Per Day $75 Copayment

Lab, X-Ray & Other Diagnostic Tests: Costs for Diagnostic Procedures

Diagnostic tests are a routine part of healthcare. Comparing the costs for simple and complex diagnostic procedures, as well as the availability and cost-sharing for enhanced lab networks, can help you estimate your expenses for routine and specialized tests.

Lab, X-Ray & Other Diagnostic Tests Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Simple Diagnostic Tests/Procedures 15% 40% + Difference Between Plan Allowance and Billed Amount 15% Or $40 Copayment Or $100 Copayment $15 Copayment
Complex Diagnostic Tests/Procedures 15% 40% + Difference Between Plan Allowance and Billed Amount $40 Or $100 $15 Copayment
Enhanced Lab Network 15% 40% + Difference Between Plan Allowance and Billed Amount N/A Member Pays Nothing

Prescription Drugs: Access and Formulary Considerations

Prescription drug coverage varies significantly among plans. Check if mail service pharmacy benefits are offered, if there are restrictions on mail order or specialty pharmacies, and whether hormone therapy is covered. Crucially, compare the cost-sharing for different drug tiers to understand your potential out-of-pocket costs for medications.

Prescription Drugs Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Mail Service Pharmacy Benefit Yes No No Yes
Mail Order Pharmacy Restriction Yes N/A N/A Yes
Specialty Pharmacy Restriction Yes N/A Yes Yes
Hormone Therapy Covered Covered Covered Covered
Tier 0 Prescription Member Pays Nothing 40% + Difference Between Plan Allowance and Billed Amount N/A Member Pays Nothing
Tier 1 Prescriptions $10 Copayment 40% + Difference Between Plan Allowance and Billed Amount $15 Copayment $10
Tier 2 Prescriptions 50% $200 Max 40% + Difference Between Plan Allowance and Billed Amount $75 Copayment 30% $200 Max
Tier 3 Prescriptions 50% $300 Max 40% + Difference Between Plan Allowance and Billed Amount 60% 50% $200 Max
Tier 4 Prescriptions 50% $350 Max 40% + Difference Between Plan Allowance and Billed Amount $120 Copayment 30% $225 Max
Tier 5 Prescriptions 50% $700 Max 40% + Difference Between Plan Allowance and Billed Amount $200 Copayment 30% $225 Max
Tier 6 Prescriptions N/A 40% + Difference Between Plan Allowance and Billed Amount N/A 30% $275 Max

Treatment, Devices, and Services: Comprehensive Coverage Options

A good health insurance plan offers comprehensive coverage for a range of treatments, devices, and services. Compare plans based on coverage for Applied Behavioral Analysis (ABA), chiropractic care, therapy services (occupational, physical, speech), mental health and substance use disorder services, infertility services, surgical procedures, hearing services, maternity care, hospice care, home health services, durable medical equipment, diabetes education, and nutritional counseling.

Treatment, Devices, and Services Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Applied Behavioral Analysis (ABA) 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment Or $50 Copayment $15 Copayment
Chiropractic Member Pays All Charges Member Pays All Charges $35 Copayment $15 Copayment
Occupational Therapy 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment Or $50 Copayment $15 Copayment
Physical Therapy 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment Or $50 Copayment $15 Copayment
Speech Therapy 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment Or $50 Copayment $15 Copayment
Professional Services (Mental Health and Substance Use Disorder) 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment $15 Copayment
Inpatient Hospital (Mental Health and Substance Use Disorder Services) 15% 40% + Difference Between Plan Allowance and Billed Amount $350 Copayment $75 Copayment $750 Max
Outpatient Hospital (Mental Health and Substance Use Disorder Services) 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment $15 Copayment
Infertility Services 15% 40% + Difference Between Plan Allowance and Billed Amount 30% $15 Copayment
Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services) 15% 40% + Difference Between Plan Allowance and Billed Amount 30% $15 Copayment
Artificial Insemination Services (e.g. ICI, IVI, IUI) 15% 40% + Difference Between Plan Allowance and Billed Amount 30% $15 Copayment
Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services) Member Pays All Charges Member Pays All Charges Member Pays All Charges Member Pays All Charges
Surgical Procedures 15% 40% + Difference Between Plan Allowance and Billed Amount $150 Copayment Member Pays Nothing
Reconstructive Surgery 15% 40% + Difference Between Plan Allowance and Billed Amount $150 Copayment Member Pays Nothing
Gender Affirming Surgery 15% 40% + Difference Between Plan Allowance and Billed Amount $150 Copayment Member Pays Nothing
Hearing Services 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment Or $50 Copayment $15 Copayment
Hearing Aids (External) Not Covered Not Covered Covered Covered
Maternity Care Member Pays Nothing 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing Member Pays Nothing
Maternity Care – Hospital Stay 15% 40% + Difference Between Plan Allowance and Billed Amount $350 Copayment Member Pays Nothing
Hospice Care 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays Nothing $5 Copayment
Home Health Services (Skilled Nursing Care) 15% 40% + Difference Between Plan Allowance and Billed Amount Member Pays All Charges $15 Copayment
Durable Medical Equipment 15% 40% + Difference Between Plan Allowance and Billed Amount 30% Member Pays Nothing
Outpatient Rehabilitation (Skilled Nursing Care Facility) 15% 40% + Difference Between Plan Allowance and Billed Amount $35 Copayment $75 Copayment
Diabetes Education Member Pays Nothing Member Pays All Charges $35 Copayment Or $50 Copayment Member Pays Nothing
Nutritional Counseling Member Pays Nothing Member Pays All Charges Member Pays Nothing Member Pays Nothing

Dental and Vision Coverage: Beyond Medical Benefits

While this comparison primarily focuses on medical benefits, dental and vision coverage are also important. Note whether each plan includes routine dental and vision exams, restorative dental care, orthodontics, and coverage for eyeglasses and contacts.

Dental Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Routine Dental Exams and Cleaning for Adults Yes No Yes No
Routine Dental Exams and Cleaning for Children Yes No Yes No
Minor Restorative for Adults No No No No
Minor Restorative for Children No No No No
Major Restorative for Adults No No No No
Major Restorative for Children No No No No
Orthodontic No No No No
Vision Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Routine Eye Exams Yes Yes No No
Eye Exams for Medical Condition or Non-Surgical Treatment Yes Yes Yes Yes
Eyeglass Frames & Lenses Yes Yes No Yes
Contacts Yes Yes No Yes

Alternative Care and Chronic Disease Management

Many FEHB plans offer coverage for alternative care services and chronic disease management programs. Check if plans cover services like acupuncture, massage therapy, and disease management for conditions like asthma, heart disease, hypertension, and obesity.

Alternative Care Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Alternative Care Yes Yes Yes Yes
Chronic Disease Management: Asthma Covered Not Covered Covered Covered
Chronic Disease Management: Heart Disease Covered Not Covered Covered Covered
Chronic Disease Management: Hypertension Covered Not Covered Covered Covered
Chronic Disease Management: Obesity Covered Not Covered Covered Covered

Plan Quality and Customer Service Ratings

Beyond costs and coverage, the quality of care and customer service provided by a health plan are crucial factors. The FEHB program provides quality ratings in several key areas, including controlling high blood pressure, diabetes management, prenatal care timeliness, appropriate antibiotic use, asthma medication management, breast cancer screening, and follow-up care after emergency department visits for mental health and substance abuse. Customer service ratings include overall plan satisfaction, claims processing, ease of getting needed care, and coordination of care. These ratings can offer valuable insights into the member experience with each plan.

Quality & Customer Service Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) Blue Cross and Blue Shield Service Benefit Plan (Basic) GEHA Benefit Plan (HDHP) MHBP Consumer Option (HDHP)
Controlling High Blood Pressure
Hemoglobin A1c Control for Patients with Diabetes
Timeliness of Prenatal Care
Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Ages 18 to 64
Asthma Medication Ratio
Breast Cancer Screening
Follow Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 30 day
Follow Up After Emergency Department Visit for Mental Illness 30 day
Childhood Immunization Status—Combination 10
Use of Imaging Studies for Low Back Pain
Overall Plan Satisfaction
Claims Processing NA NA NA
Getting Needed Care
Coordination of Care NA

Making Your Choice: Informed Decision-Making

This comparison tool provides a comprehensive overview to help federal employees compare health insurance plans. However, it is not an official statement of benefits. Before making your final enrollment decision, always refer to the individual FEHB brochure for the official statement of benefits. Carefully review the plan brochures and consider your personal healthcare needs, expected medical expenses, and risk tolerance to select the FEHB plan that offers the best value and coverage for you and your family.


Disclaimer: The information provided in this comparison is for informational purposes only and should not be considered as official benefit information. Always consult the official plan brochures for detailed and accurate benefit information.

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