best federal government insurance plan for families?

[Anonymous]

we just had a child and are now re-evaluating our health insurance options since it's a "qualifying event." our current plan is an excellent PPO plan (basically everything is covered, i don't have to get referrals to see specialists, tons of in network doctors so i usually only pay a co-pay but even if out of network i only pay a small portion). but i'm not sure how much longer i'll be at my current employer and the premiums are so high, so we are considering switching to one of the federal government employee options my husband is eligible for.

so for those of you who are on the fed govt plans, which do you use and like? i'd like to keep a similar type PPO plan, but i don't see any PPO options listed on the site. am i missing something? there are so many options and no way to compare them easily, it's overwhelming so help from anyone with experience in this would be very much appreciated.

[Anonymous]

We have BlueCross BlueShield (standard option) and find it sufficient. They have especially good prenatal/delivery coverage, if you are planning to have another child.

[Anonymous]

I think the BCBS plan would fit your bill. That's what we have and, although co-pays and deductibles have gone up in the past couple years, it still provides one of the best family coverages. No referals required, large network, etc. And as pp mentioned, the prenatal coverage is excellent. Basically you pay nothing.

[Anonymous]

I have had Aetna Open Access HMO since I started working for the government - almost 10 years, and have been very happy with them. While it is an HMO, referrals are not required. I paid next to nothing for both of my deliveries, and one was a complicated c-section where my child ended up in the nicu for a few days. I saw the 30K+ medical bills, and paid only my hospitalization copay of $600 max for a 4 day hospitalization. The network is large, and there is a simple dental plan included.

[Anonymous]

Anonymous wrote:I have had Aetna Open Access HMO since I started working for the government - almost 10 years, and have been very happy with them. While it is an HMO, referrals are not required. I paid next to nothing for both of my deliveries, and one was a complicated c-section where my child ended up in the nicu for a few days. I saw the 30K+ medical bills, and paid only my hospitalization copay of $600 max for a 4 day hospitalization. The network is large, and there is a simple dental plan included.

Same here. We had Aetna Open Access through DH's job (non-federal) and when we switched to my plan (fed) we kept it. Never had a problems finding/seeing a doctor or specialist, practically everything is covered including mental heath/therapy, and prescriptions are reasonable. Generics are $10 but if you go to Safeway or Target, they are usually $4 anyway.

[Anonymous]

We also have Aetna Open Access and are happy with them. Our delivery cost was a little higher than what 07:58 posted (also a C-section and NICU), but still reasonable, and the copays and costs for regular medical care are low. I like having the dental plan included.

[Anonymous]

I have Aetna open access also, and you pat 10% of hospital stays. With the single room charge at sibley, it ended up being $2k or so...not next to nothing for us!

[Anonymous]

Another Aetna Open Access (basic or standard plan) here. Since they did away w/ referrals for specialists, I think it became an even better deal. I believe last time I compared, the copays for visits (other than well-baby which have no co-pay) are higher than some other plans like BCBS, and the same w/ hospital stays, but you have to compare what you pay in premiums too; Aetna is lower. I've been happy w/ their customer service on fixing errors, etc. And I've had no trouble finding primary care docs or specialists.

[Anonymous]

sorry - meant you "pay"

[Anonymous]

We have Aetna Open Access HMO as well. We used to have the HIGH option, which meant a max of $150/night for hospital stays with a max of $450, so our delivery costs were "next to nothing"

After the birth of our child, we switched to the high deductible option, so the costs are 10% of hospital stays -- there is a max, but I don't remember what it is. Overall, we've been very happy with AETNA and like that you don't need referrals. Researching the high/low deductive options might be important to you, particularly if you anticipate hospital stays (the higher co-pays are negligible, like $10 more / visit). Overall the network is huge and not having to get a referral is great. Billing errors have been fixed promptly and customer service is always great.

[Anonymous]

We also have Aetna Open Access HMO and have generally been pleased. I've found plenty of choice in network providers, and I like not having to deal with a referral. The few times we've had medical issues away from home, they've been easy to deal with as well.

I do re-evaluate each year at enrollment time, but so far we've stuck with the same plan for 6 years.

[Anonymous]

I'm in the same boat re deciding on new health insurance and was going to go for BCBS standard, but now am reconsidering based on these posts about Aetna Open Access HMO. I've always associated HMO with "bad" and FFS/PPO with "good." Can someone please explain what the downside to this HMO is? I see my DC's ped takes it, but my own doctor doesn't. Do I have to switch doctors or do they instead just pay like 80% for out of network like a PPO does? What about hospital visits? Do you have issues if you have to go to the hospital/emergency room with figuring out whether your procedure is covered? Is the network also this extensive outside the DC area? (we visit family on the west coast often and want ot make sure we wouldn't encounter any issues if DC needed medical treatment for whatever reason while we're out there.)

[Anonymous]

Likewise a happy Aetna Open Access customer.

[Anonymous]

I have BCBS standard and paid $0 for my two night hospital stay. I think they will bill me for a $150 co-pay but that has yet to happen. The only thing I don't like is that each time I bring my child to the ped it is a $25 co-pay.

[Anonymous]

We have also used Aetna Open Access for years and been very happy with it. It's not as good as the plan I had from my former employer (United Healthcare) which I thought was phenomenal, but I find that more of our doctors take Aetna than BCBS (we switched when our pediatrician stopped taking BCBS).

It's a bit silly that they call it an HMO because I don't think it really is - you get to choose your doctors and your specialists and whether or not you want to see a specialist, which you can do without a referral. To me that is not how an HMO operates....