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.
