Author Topic: US federal employees: do you like APWU's consumer-driven health plan?  (Read 20017 times)

Monkey Uncle

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It's health insurance open season for federal employees, so I'm shopping around for something less expensive than my current Blue Cross fee-for-service plan.  I'm looking at the APWU consumer-driven option, which seems almost too good to be true.  (In case you're interested, the gory details are here: http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/brochures/71-004.pdf#page=148)

-- Family premium amounts to $2,744 for an entire year, including the union dues that you have to pay to get into the plan.

-- Each year they give you a $2,400 Personal Care Account (PCA), which pays 100% of health care costs until it is exhausted.

-- Once the PCA money is gone, the plan behaves like a normal fee-for-service plan.  You then have to meet a $600 per person/$1,200 per family deductible, after which you pay 15% coinsurance (40% on out-of-network providers).  The annual maximum out of pocket is a very reasonable $4,500 (not-so-reasonable $9,000 for out of network providers).

-- If you don't use your entire PCA amount, the unused balance rolls over into the next year, and they also apply that same amount toward next year's deductible.  You basically get double the amount of whatever portion of the PCA you manage to save.

So, if you're healthy and can keep your family's total annual health costs under $2,400, you get a year's worth of health care for just the cost of the premiums.

If you have a major health expense, things don't work out so well.  For example, my wife had $16,000 worth of emergency surgery this year.  Had we been on this plan, our total health expenses (including premiums) would have been at least several hundred more than we paid with our current Blue Cross plan.  But in a more normal year, it looks like we would save about $2,000 relative to the Blue Cross Plan, assuming we could operate within the $2,400 PCA.

I can't help but have the feeling that I'm missing some big "gotcha."  My main problem is that I've never tracked the real cost of Dr. visits, tests, outpatient stuff, etc., because I've always just paid a modest co-pay.  I don't really know how far that $2,400 will go.  Is it realistic for relatively healthy middle-aged people to keep total annual medical expenses under this amount?

I'm also interested in hearing from anyone who has this APWU consumer driven plan.  How is it working for you?
« Last Edit: November 17, 2014, 04:28:37 AM by Monkey Uncle »

Schnurr

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #1 on: November 17, 2014, 11:22:03 AM »
I was thrown by your earlier statement about only paying $344, but it appears you've corrected it. It does seem like you would only pay the $2744 in premiums, if your health care costs did not exceed $2400. I've always felt that Blue Cross is very expensive compared to other FEHB plans, so I am not surprised that you could save a good amount by switching. Do you live in an area covered by Kaiser Permanente? Their standard plan costs the same as the APWU plan, but there is no deductible and no coinsurance, just some relatively affordable copayments. I've been with Kaiser for several years and have been satisfied.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #2 on: November 18, 2014, 04:00:58 AM »
I was thrown by your earlier statement about only paying $344, but it appears you've corrected it. It does seem like you would only pay the $2744 in premiums, if your health care costs did not exceed $2400. I've always felt that Blue Cross is very expensive compared to other FEHB plans, so I am not surprised that you could save a good amount by switching. Do you live in an area covered by Kaiser Permanente? Their standard plan costs the same as the APWU plan, but there is no deductible and no coinsurance, just some relatively affordable copayments. I've been with Kaiser for several years and have been satisfied.

Yeah, I shouldn't attempt arithmetic past 9:00 pm after I've spent all day poring over insurance booklets.  But $2744 still sounds pretty good.

The Kaiser plan sounds like the Blue Cross plan that I currently have, except it costs more than $1K less.  I wish I had that option, but it's not offered in my state.

chuckaluck

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #3 on: November 18, 2014, 04:41:54 AM »
My wife and I have never purchased health insurance by trying to find one that has lower monthly premiums instead of one that better pays for catastrophic care.  (We have had BC/BS for many years.  But there are similar plans).  We have always known that we were paying 10.00 to 20.00 more per pay period for BC/BS than we could have purchasing other plans.  However, BC/BS had all the doctors we wanted, and it has had as good catastrophic care as any others.  This past year, my wife had medical issues that cost nearly 200,000.00, of which we paid very little out of pocket (about 7,000.00). While I have not done an exhaustive comparison between the BC/BS and a plan with a lower premiums, I am confident that we saved many thousands of dollars more with BC/BS.    I guess the bottom line is that with health insurance, we did not want to be "penny wise and dollar foolish". 

kimmarg

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #4 on: November 18, 2014, 05:12:15 AM »
There's a website called "plan smart choice" that let's you put in you're expected expenses and shows how the costs change by plan, also shows other ratings.  Cost isn't everything. I switched off blue cross to GEHA a year or so ago. They were so awful I decided I would rather pay a bit more. bCBS has never denied  or debated my claims. I spent hours on hold with GEHA trying to get my migraine medication. So ask your coworkers about ratings, service etc.

Neustache

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #5 on: November 18, 2014, 05:27:41 AM »
We've had a great experience with GEHA.  YMMV. 

ETA:  We had some major claims after switching to them.  Kiddo spent overnight at the local children's hospital for asthma, then all the follow up stuff involved with getting him dx with asthma.  They paid claims quickly and paid what they were supposed to pay, and I had no problem getting everything I needed as far as prescriptions.  I've personally never had a carrier pay claims as quickly as they did. 
« Last Edit: November 18, 2014, 05:32:21 AM by Neustache »

enigmaT120

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #6 on: November 18, 2014, 10:40:27 AM »
I was thrown by your earlier statement about only paying $344, but it appears you've corrected it. It does seem like you would only pay the $2744 in premiums, if your health care costs did not exceed $2400. I've always felt that Blue Cross is very expensive compared to other FEHB plans, so I am not surprised that you could save a good amount by switching. Do you live in an area covered by Kaiser Permanente? Their standard plan costs the same as the APWU plan, but there is no deductible and no coinsurance, just some relatively affordable copayments. I've been with Kaiser for several years and have been satisfied.

My Kaiser plan has a deductible, though it's pretty small.  A couple of hundred dollars per person?  Something like that.  I doubt I'll switch.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #7 on: November 19, 2014, 04:01:35 AM »
My wife and I have never purchased health insurance by trying to find one that has lower monthly premiums instead of one that better pays for catastrophic care.  (We have had BC/BS for many years.  But there are similar plans).  We have always known that we were paying 10.00 to 20.00 more per pay period for BC/BS than we could have purchasing other plans.  However, BC/BS had all the doctors we wanted, and it has had as good catastrophic care as any others.  This past year, my wife had medical issues that cost nearly 200,000.00, of which we paid very little out of pocket (about 7,000.00). While I have not done an exhaustive comparison between the BC/BS and a plan with a lower premiums, I am confident that we saved many thousands of dollars more with BC/BS.    I guess the bottom line is that with health insurance, we did not want to be "penny wise and dollar foolish".

I failed to mention that the APWU plan has a lower catastrophic out-of-pocket limit than the Blue Cross plan that I'm on now (4,500 vs. 7,000).  So in a scenario such as yours, we'd actually end up spending less out of pocket, in addition to saving about $1,800 on the premium.  Where we'd end up spending more is in a mid-range expense scenario, like the $16k surgery that my wife had this year.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #8 on: November 19, 2014, 04:05:20 AM »
There's a website called "plan smart choice" that let's you put in you're expected expenses and shows how the costs change by plan, also shows other ratings.  Cost isn't everything. I switched off blue cross to GEHA a year or so ago. They were so awful I decided I would rather pay a bit more. bCBS has never denied  or debated my claims. I spent hours on hold with GEHA trying to get my migraine medication. So ask your coworkers about ratings, service etc.

We switched to GEHA for a few years, but then had to switch back to BC/BS when most of our local providers dropped GEHA.  Most of them have picked up GEHA again, so I'm considering it as well as the APWU plan.  But I'm not sure I would save much with GEHA.  The premium is almost $1K less, but it has a $700 deductible and 15% coinsurance, so it may end up being a wash.

I'll have to check out the plan smart choice site.  That scenario-playing is just the kind of thing I could spend hours doing on a rainy Sunday.
« Last Edit: November 19, 2014, 04:07:47 AM by Monkey Uncle »

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #9 on: November 26, 2014, 11:21:46 AM »
There's a website called "plan smart choice" that let's you put in you're expected expenses and shows how the costs change by plan, also shows other ratings.  Cost isn't everything. I switched off blue cross to GEHA a year or so ago. They were so awful I decided I would rather pay a bit more. bCBS has never denied  or debated my claims. I spent hours on hold with GEHA trying to get my migraine medication. So ask your coworkers about ratings, service etc.

We switched to GEHA for a few years, but then had to switch back to BC/BS when most of our local providers dropped GEHA.  Most of them have picked up GEHA again, so I'm considering it as well as the APWU plan.  But I'm not sure I would save much with GEHA.  The premium is almost $1K less, but it has a $700 deductible and 15% coinsurance, so it may end up being a wash.

I'll have to check out the plan smart choice site.  That scenario-playing is just the kind of thing I could spend hours doing on a rainy Sunday.

After running some scenarios, I have to say I am skeptical of the plan smart choice calculator's accuracy.  I put in our actual cost for health care expenses this year (including my wife's $16k surgery), and it gave me an out of pocket cost for my current BC plan that was twice our actual cost.  And when I ran several high-cost scenarios, it kept telling me the APWU's out of pocket costs would be $5,700, even though the plan brochure plainly states that it has a $4,500 per family out of pocket limit.  I emailed the site admins asking why their calculator was returning such results, but they have not responded to me.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #10 on: November 30, 2014, 04:29:46 AM »
I figured out that the APWU plan doesn't count the $1,200 deductible toward the $4,500 out of pocket limit.  Thus the real out of pocket limit is $5,700.  Sneaky bastards.  But that's still less than BC's $7,000 out of pocket limit.  And I still haven't figured out why plan smart choice calculated my BC out of pocket at twice what I actually incurred.

I may be talking to myself at this point in the thread; posting this follow-up in case anyone is still listening.  :)

BuildingFrugalHabits

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #11 on: November 30, 2014, 08:29:31 AM »
Have you considered one of the HDHP plans available such as GEHA's HDHP or Aetna's HDHP? 

Looks like the premium for family for GEHA is $252 but $125 goes towards your HSA so really you are paying $125 per month.  The deductible for family is $3000 in network.  Then there are some tax advantages to using an HSA account.  I'm currently weighing these options as well. 

sol

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #12 on: November 30, 2014, 08:58:41 AM »
I may be talking to myself at this point in the thread; posting this follow-up in case anyone is still listening.  :)

You're not talking to yourself, I'm still listening with interest.

We've had BCBS family for years, and are relatively happy with it, but I've been debating making the switch this year.  The biggest loss for us, I think is going to be dental.  BCBS pays for routine teeth cleanings minus the little copay, and without knowing what we would actually pay for our family of five for dentist visits, it's hard to do a comparison.  On Monday I'll call our dentist and ask them what their cash rate is, and I'll go from there.

charis

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #13 on: November 30, 2014, 09:00:11 AM »
I am in this boat as well.  We just signed for Aetna HDHP.  I compared other plans, but the HSA with tax benefits and 125/mon plan contributions make the other plans less appealing.  The plan gives you half of the deductible in your HSA and preventive care is completely covered.

BuildingFrugalHabits

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #14 on: November 30, 2014, 10:06:14 AM »
I am in this boat as well.  We just signed for Aetna HDHP.  I compared other plans, but the HSA with tax benefits and 125/mon plan contributions make the other plans less appealing.  The plan gives you half of the deductible in your HSA and preventive care is completely covered.

Thoughts on GEHA HDHP vs Aetna HDHP?  Same deductible but Aetna has the lower cap on out of pocket 4k/8k vs 6k/12k.  GEHA has lower coinsurance 5% vs 10%.  Aetna is slightly more expensive.  Ahh my head hurts! 

Does anyone have any information on the HSA accounts?  Apparently GEHA uses HSA Bank whereas Aetna uses JP Morgan.  I'm wondering what investment options and fees are like with these options.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #15 on: November 30, 2014, 10:08:11 AM »
Have you considered one of the HDHP plans available such as GEHA's HDHP or Aetna's HDHP? 

Looks like the premium for family for GEHA is $252 but $125 goes towards your HSA so really you are paying $125 per month.  The deductible for family is $3000 in network.  Then there are some tax advantages to using an HSA account.  I'm currently weighing these options as well.

I had initially dismissed the GEHA HDHP because I was scared away by the $3k deductible and $12k out of pocket limit.  But the 5% coinsurance means that you'd have to rack up some pretty extreme costs to hit that limit.  I ran a scenario in plansmartchoice that had me in the hospital once and my wife in twice at $100,000 per incident, and it came pretty close to maxing the out of pocket ($10,500).  What's the likelihood that such a scenario would ever happen?  Who knows?  That's what I hate about the health insurance game - it's impossible to figure out the best option.  You can save a lot of money with cheap insurance, if you stay healthy.  But if you have major health problems, you're going to pay dearly for that cheap insurance.  My family is generally healthy, but shit happens.  Like my son's $20k appendix operation two years ago, and my wife's $16k ovarian torsion this year.  Neither of those had anything to do with predictable poor health issues or bad lifestyle choices, but they happened anyway.  Prior to those incidents, we hadn't had a major health expense for a decade.

Actually, the GEHA option probably isn't even in the mix for me.  In all of the ordinary cheap simulations, the APWU is hands-down the most cost effective choice that is available in my area (when I say available, I mean it is offered and it has a reasonably broad PPO network).  My current BC plan wins in all of the moderately and severely costly simulations.  But I'm still no closer to choosing between the two.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #16 on: November 30, 2014, 10:12:17 AM »
I may be talking to myself at this point in the thread; posting this follow-up in case anyone is still listening.  :)

You're not talking to yourself, I'm still listening with interest.

We've had BCBS family for years, and are relatively happy with it, but I've been debating making the switch this year.  The biggest loss for us, I think is going to be dental.  BCBS pays for routine teeth cleanings minus the little copay, and without knowing what we would actually pay for our family of five for dentist visits, it's hard to do a comparison.  On Monday I'll call our dentist and ask them what their cash rate is, and I'll go from there.

All the dentists in our area dropped BC years ago because of their pathetic allowances for dental work.  So we've been self-funding our family dental care for a while.  A routine cleaning costs about $75, if I remember correctly.  About double that if x-rays are done.  We have good teeth, so we've cut back to annual visits instead of every 6 months.  Of course, costs in your area are likely to be different.

sol

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #17 on: November 30, 2014, 10:13:30 AM »
Reading over the APWU plan materials, I have a couple of concerns.

The first is that the Personal Care Account isn't really an HSA because you forfeit any unused balance when you leave the plan, for example when you retire early.  For us, one of the benefits of changing insurance providers now is to build up an HSA balance while we have high incomes so that we have that money available to us for healthcare between retiring and starting medicare, when we expect to have to buy insurance through the ACA.

The PCA is only $2400 regardless of family size.  We're insuring five people.  We could burn through that amount just with dentist visits that BCBS currently covers with only a $25 copay per visit. 

It's not clear to me if you can still use a Flexible Spending Account with the APWU plan.  Losing this tax benefit at higher incomes hurts.

...and preventive care is completely covered.

I think the ACA mandated that preventative care is always covered.  It's not really a selling point if every plan has to offer it.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #18 on: November 30, 2014, 10:17:30 AM »
I am in this boat as well.  We just signed for Aetna HDHP.  I compared other plans, but the HSA with tax benefits and 125/mon plan contributions make the other plans less appealing.  The plan gives you half of the deductible in your HSA and preventive care is completely covered.

Thoughts on GEHA HDHP vs Aetna HDHP?  Same deductible but Aetna has the lower cap on out of pocket 4k/8k vs 6k/12k.  GEHA has lower coinsurance 5% vs 10%.  Aetna is slightly more expensive.  Ahh my head hurts! 

Does anyone have any information on the HSA accounts?  Apparently GEHA uses HSA Bank whereas Aetna uses JP Morgan.  I'm wondering what investment options and fees are like with these options.

Can't help you much with this one, as Aetna is not available here.  But in general, the lower coinsurance/higher out of pocket option should be less expensive overall, except when you have a really bad health year.

kendallf

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #19 on: November 30, 2014, 12:58:02 PM »
I've had the Aetna HDHP for the past year.  I have used it zero times, but I am using the Chase investment account.  The investment choices are fairly limited, and the fees aren't great either, but at least I can put that money in the market.

I'm switching to MHBP Consumer Option this year (another HDHP).  They're slightly more expensive and have higher deductible, but their copay is better if you should need hospitalization ($75/day capped at $750, I believe, vs. 10 or 20% for the other HDHP options).  Also, MHBP passes $1690/year through into your HSA vs. 1500 for Aetna, giving you back part of the premium increase.

It's probably pretty close to a wash but I decided I'd pay the ~$300/year difference for what I hope is slightly better coverage should I need it.

Almost forgot to add: I think I'm going to open an HSA Bank account and transfer my HSA investments there (closing the Chase HSA after the switch from Aetna becomes effective).  Then I'll transfer money out of MHBP's HSA account periodically to invest.  I'd like to have one account I can keep if I switch HDHPs.

charis

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #20 on: November 30, 2014, 01:13:00 PM »
I think the ACA mandated that preventative care is always covered.  It's not really a selling point if every plan has to offer it.

That it is covered by every plan is a selling point for a HDHP.

charis

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #21 on: November 30, 2014, 01:19:30 PM »
I am in this boat as well.  We just signed for Aetna HDHP.  I compared other plans, but the HSA with tax benefits and 125/mon plan contributions make the other plans less appealing.  The plan gives you half of the deductible in your HSA and preventive care is completely covered.

Thoughts on GEHA HDHP vs Aetna HDHP?  Same deductible but Aetna has the lower cap on out of pocket 4k/8k vs 6k/12k.  GEHA has lower coinsurance 5% vs 10%.  Aetna is slightly more expensive.  Ahh my head hurts! 

Does anyone have any information on the HSA accounts?  Apparently GEHA uses HSA Bank whereas Aetna uses JP Morgan.  I'm wondering what investment options and fees are like with these options.

GEHA is practically unheard of around here.  And what I have heard has all been bad - as far as getting claims paid.  I will pay slightly more for the company with a better rep on that front.  Aetna is more common around here.  Also, I think that although the premiums are a bit higher, the contributions to the HSA are a bit higher.  I actually don't remember there being much difference between the two plans as far as coverage and price except for the out of pocket limit.

I can't help on the HSA questions, but I would love to know.  I just got my debit card from Aetna today, but I can't figure out how to access the account online and start contributing.  I was on the computer for an hour today trying to figure it out.

kendallf

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #22 on: November 30, 2014, 09:10:39 PM »

I can't help on the HSA questions, but I would love to know.  I just got my debit card from Aetna today, but I can't figure out how to access the account online and start contributing.  I was on the computer for an hour today trying to figure it out.

It will take some time before they activate the HSA portion your account on Aetna Navigator, if my experience last year is a guide.  There was no HSA option showing whatsoever; it took several weeks for it to finally appear, and I had no account info to start automatic payroll deductions until after the 1st of the year when the change actually took effect. 

This is not covered anywhere on the Navigator site that I could find, but after multiple messages to their help center, that's the reply I finally got.

Monkey Uncle

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #23 on: December 01, 2014, 03:56:22 AM »
I think the ACA mandated that preventative care is always covered.  It's not really a selling point if every plan has to offer it.

That it is covered by every plan is a selling point for a HDHP.

Actually, I think all of the plans have to cover it, HDHP or not.

charis

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Re: US federal employees: do you like APWU's consumer-driven health plan?
« Reply #24 on: December 01, 2014, 05:43:20 AM »
I think the ACA mandated that preventative care is always covered.  It's not really a selling point if every plan has to offer it.

That it is covered by every plan is a selling point for a HDHP.

Actually, I think all of the plans have to cover it, HDHP or not.

Maybe I am not being clear.  The fact that it is covered by every plan is a selling point for an HDHP because you pay more for preventive coverage on a traditional co-pay plan - through higher premiums and per-visit copays.  Obviously this assumes a generally healthy person, which is probably why you would be looking at a HDHP.