Federal Health Insurance Compare: A Comprehensive Guide for US Federal Employees

Choosing the right federal health insurance plan can be a daunting task. With numerous options available under the Federal Employees Health Benefits (FEHB) Program, understanding the differences in coverage, costs, and benefits is crucial. This guide provides a detailed comparison of several federal health insurance plans, helping you make an informed decision that best suits your needs and those of your family.

Disclaimer: The information provided in this comparison is for informational purposes only and should not be considered the official statement of benefits. Always refer to the official plan brochure for complete and accurate benefit details before making your final enrollment decision.

Understanding Your Federal Health Insurance Options

The FEHB Program offers a variety of health insurance plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Fee-for-Service (FFS) plans, and High Deductible Health Plans (HDHPs). Each plan type has different features, provider networks, and cost-sharing structures. This comparison focuses on several High Deductible Health Plans (HDHPs), which are becoming increasingly popular due to their lower premiums and the option to pair them with a Health Savings Account (HSA).

HDHPs generally feature lower premiums but higher deductibles compared to traditional plans. They are often paired with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA), which can help offset out-of-pocket costs. Understanding these key terms is essential when comparing federal health insurance plans:

  • Premium: The regular payment you make to maintain your health insurance coverage.
  • Deductible: The amount you pay out-of-pocket for covered healthcare services before your plan starts to pay.
  • Coinsurance: The percentage of the cost of a covered healthcare service you pay after you’ve met your deductible.
  • Copayment: A fixed amount you pay for a covered healthcare service, like a doctor’s visit.
  • Out-of-Pocket Maximum: The most you’ll have to pay in cost-sharing (deductibles, copayments, and coinsurance) for covered in-network services during a plan year.
  • HSA (Health Savings Account): A tax-advantaged savings account that can be used to pay for qualified medical expenses. HDHPs are often HSA-compatible.
  • HRA (Health Reimbursement Arrangement): An employer-funded account that reimburses employees for qualified medical expenses.

It’s also important to understand the different enrollment types available:

Self: Coverage for just the employee.

Self Plus One: Coverage for the employee and one eligible family member.

Self & Family: Coverage for the employee and multiple eligible family members.

Note: In some instances, the premium for “Self Plus One” enrollment may be higher than “Self and Family”. Always compare premiums for both options if you wish to cover one family member. You can check the most up-to-date premium information at www.opm.gov/fehbpremiums.

Federal Health Plan Comparison Table

The following table compares key features of several federal health insurance plans. This comparison includes details on costs, network information, and member costs with Medicare.

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 Information
Plan Links 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)
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 (Self) $135.20 $113.16 $76.27 $84.20
Biweekly Premium (Self Plus One) $287.01 $274.14 $163.99 $186.33
Biweekly Premium (Self & Family) $241.49 $303.61 $201.52 $195.65
Costs & Networks
Networks In-Network / Out-of-Network In-Network 1 / In-Network 2 / Out-of-Network In-Network / Out-of-Network In-Network / Out-of-Network
Annual Deductible (Self) $1,800.00 None $1,650.00 $2,000.00
Annual Deductible (Self Plus One) $3,600.00 None $3,300.00 $4,000.00
Annual Deductible (Self & Family) $3,600.00 None $3,300.00 $4,000.00
Type of Account HSA/HRA None HSA/HRA HSA/HRA
Medical Account Contribution (Self) $800.00 N/A $1,000.00 $1,200.00
Medical Account Contribution (Self Plus One) $1,600.00 N/A $2,000.00 $2,400.00
Medical Account Contribution (Self & Family) $1,600.00 N/A $2,000.00 $2,400.00
Net Deductible (Self) $1,000.00 None $650.00 $800.00
Net Deductible (Self Plus One) $2,000.00 None $1,300.00 $1,600.00
Net Deductible (Self & Family) $2,000.00 None $1,300.00 $1,600.00
Annual Out-of-Pocket Maximum (Self) $6,900.00 None $6,000.00 $6,000.00
Annual Out-of-Pocket Maximum (Self Plus One) $13,800.00 None $12,000.00 $12,000.00
Annual Out-of-Pocket Maximum (Self & Family) $13,800.00 None $12,000.00 $12,000.00
Member Cost with Medicare A & B Primary
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 Cost with Medicare Advantage (Part C) Primary
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
Member Cost with Medicare Part D EGWP
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/Specialty Care
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 & Urgent Care
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 & Hospital Charges
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
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
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
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
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
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
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

Key to Quality & Customer Service Ratings: Outstanding Excellent Good Fair Poor NA (Not Available)

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

Making the Right Choice for Your Federal Health Insurance

Comparing federal health insurance plans involves considering various factors beyond just premiums. Think about your healthcare needs, your family’s needs, your risk tolerance, and your financial situation.

  • For individuals and families who are generally healthy and prefer lower monthly premiums: An HDHP like the GEHA Benefit Plan (HDHP) or MHBP Consumer Option (HDHP) might be attractive, especially with the added benefit of an HSA/HRA.
  • For those who anticipate needing frequent medical care or prefer lower out-of-pocket costs at the point of service: The Blue Cross and Blue Shield Service Benefit Plan (Basic), despite not being an HDHP, offers no deductible and may be a better option.
  • Consider the network: Ensure the plan you choose has a strong network of providers in your area, including your preferred doctors and hospitals.
  • Evaluate quality and customer service: The quality and customer service ratings can provide insights into the plan’s performance in areas like preventive care, chronic disease management, and member satisfaction.

Ultimately, the “best” federal health insurance plan is subjective and depends on your unique circumstances. Use this comparison tool as a starting point, and always review the official plan brochures and resources on the OPM website to make a well-informed decision.

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