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?