Best federal employee health insurance option for families?

[Anonymous]

BCBS Standard is great. Accepted at many local high-quality medical centers in both DC and Baltimore.

[Anonymous]

Kaiser is not for people who are sick or become sick..i.e. cancer, heart condition, etc. They are preventive. I would not go with an HMO. But, if you are only concerned with cost...take Kaiser and pray you don't get sick with cancer, or another health condition. And Kaiser isn't great if you are in an area and have to go to an emergency facility that does not have Kaiser doctors. You would have to sit there and wait until a Kaiser doctor to come. Other doctor can not touch you because of the Kaiser contract.

[Anonymous]

Kaiser is great if you're under 40 and reasonably healthy...my premiums + co-pays never broke $1,000/yr for about a decade. But it's time to start thinking about BCBS when your family starts growing.

[Anonymous]

Kaiser is okay for routine preventive care as well as genuinely emergency treatment -- you'll be covered at any ER if you need an emergency cath. The real problem is treatment post-stabilization, which Kaiser will say kicks in quickly. If you're in an area where there are Kaiser-affiliated preferred hospitals, like here with VHC or RHC, Kaiser may try to transfer you and say they'll stop paying if you stay where you are. Once you're at VHC or RHC, Kaiser will insist that you're treated only by Kaiser's doctors. This means that that Kaiser hospitalists or intensivists will coordinate your care, determine what tests and consults you get, and direct your overall treatment (God help you). It also means you'll have to be seen by Kaiser specialists, not the hospital's own service.

[Anonymous]

PP By the way, I am down on Kaiser hospitalists and intensivists because these are areas where I feel Kaiser is scraping the bottom of the barrel. I can see why in primary care or in certain subspecialities why a great doctor might prefer the lifestyle and stability of Kaiser versus a multi-speciality, RVU-nickel-and-diming practice. But any hospitalist and intensivist positions are going to have the same, regular, no-call schedule and similar compensation schemes. There's just no reason to sign on as the Kaiser hospitalist at Reston Hospital Center instead of going to Inova if you have a choice in the matter.

[Anonymous]

We had BCBS basic for several years, but then they had several years of above average premium increases and we switched to GEHA STD. That was a good plan, but we switched to GEHA's HDHP a couple years ago. I really like this plan. If you don't have a lot of medical expenses, this is the plan to be in. If you spend a good amount on healthcare and hit your deductible, then everything except prescriptions is 5%. There is a small band where if you spend right around $3,000 a year, BCBS basic or GEHA STD would be better, and if you spend a HUGE amount on medical in a year, other plans are better, but GEHA's HDHP is something to look at. There are also special circumstances to look out for, like with prescriptions (GEHA HDHP requires you to pay 100% of prescriptions until you hit your deductible). It also pays 100% preventative dental (checkups, x-ray, fluoride). I've put our expenses into a spreadsheet the last several years and came out ahead with GEHA's HDHP. The deductible is $3,000, but they give you $1,500 each year, so it is really $1,500.

[Anonymous]

Anonymous wrote:Love Aetna Open Access. Low cost and every one of our existing providers takes it. Big network of specialists too.

Agreee! I had bcbs for years but switched to aetna hmo two years ago. I was able to keep all of my doctors. Aetnas premiums are cheaper. My family does have medical issues and needs specialists. Our co pays have been extremely reasonable. Check it out.

[Anonymous]

I had fed bcbs standard for years before kids. Switched to mdipa for ivf coverage and loved it. Stayed with mdipa family plan with child number 1 who had a genetic condition that required a number of specialists. Even though we needed preauthorization to see the specialists, all we had to do was call our primary doc for the referrals. For kid number 2 I switched to kaiser for ivf coverage and kid number 1 went under my husbands bcbs policy. Loved kaiser but couldn't stick with them post delivery because kid number 1 had his team of specialists that I wasn't willing to lose. Brought whole family back under bcbs standard. While we still see all the sane docs we saw under mdipa, I feel like I'm always writing copay checks in pretty large amounts which I did not have to do under mdipa or kaiser. Considering switching back to mdipa.

[Anonymous]

Anonymous wrote:Kaiser is not for people who are sick or become sick..i.e. cancer, heart condition, etc. They are preventive. I would not go with an HMO. But, if you are only concerned with cost...take Kaiser and pray you don't get sick with cancer, or another health condition. And Kaiser isn't great if you are in an area and have to go to an emergency facility that does not have Kaiser doctors. You would have to sit there and wait until a Kaiser doctor to come. Other doctor can not touch you because of the Kaiser contract.

I don't agree with this. I have two people close to me with serious conditions, one a sibling, and Kaiser went immediately out of network to provide for both. No questions asked. Both were in their 40s; one had cancer and another multiple strokes resulting in brain surgery.

[Anonymous]

The problem with Kaiser is not when you have to go out of network, but rather when there is a Kaiser in-network option that is subpar. It could be something exotic (like a radiation oncology modality or specialized rehab) or something as routine as an urgent-but-not emergent general surgery procedure. You do not want pleurodesis and then a week-long recovery in the stepdown unit at Reston Hospital Center under the care of Kaiser hospitalists.

[Anonymous]

NALC is cheaper than BCBS standard and uses the Cigna network. I haven't had any issues with coverage and pay a lot less in premiums.

[Anonymous]

We've had NALC for 6 years. This is the first year we've had major problems with them. Problems in previous years have been annoying, but this year the problems are potentially life-threatening. We're moving to BCBS. I'm sure NALC will be glad to see us gone. If you actually need insurance for serious illnesses or mental health care, I wouldn't go with NALC -- it's not for people who actually get sick.

If you have a child with ADHD you'll want to note that starting next year, they will require pre-approval for ADHD medications.

They are stating that weekly psychotherapy for a child (with anxiety and ADHD) is not medically necessary, and they will only approve one visit a month. This child was self-injuring earlier this year, and is coping now only due to expanded IEP accommodations and weekly psychotherapy. They are not following the rules on the appeals process, and are dragging their feet as much as they can and 'losing' needed information and our documentation, which further delays the appeal. It's truly appalling. We are now paying out of pocket for the absolutely needed weekly visits.

They also are restricting access to a kidney transplant needed by another family member. They have their own 'managed care' that those needing any transplants are required to use. The reality is that they use it to restrict access to care by being very slow to approve tests, slow to respond to phone calls from the transplant hospital and related medical team, and only paying for transplants at a very limited number of transplant centers (many of those that they will cover have transplant list wait times that are years longer than those at 'disallowed' transplant centers.) NALC pays NOTHING for going 'out of network' for an organ transplant. Rather than wait an extra 2-5 years for a kidney transplant, we'll move to BCBS and try for a transplant at a hospital with a shorter expected wait time.

So, the issues that we are facing with NALC may not be related to your family's needs, but be aware that NALC may cause problems for your family's health care if providing coverage suddenly becomes expensive for them.

[Anonymous]

Anonymous wrote:We've had NALC for 6 years. This is the first year we've had major problems with them. Problems in previous years have been annoying, but this year the problems are potentially life-threatening. We're moving to BCBS. I'm sure NALC will be glad to see us gone. If you actually need insurance for serious illnesses or mental health care, I wouldn't go with NALC -- it's not for people who actually get sick.

If you have a child with ADHD you'll want to note that starting next year, they will require pre-approval for ADHD medications.

They are stating that weekly psychotherapy for a child (with anxiety and ADHD) is not medically necessary, and they will only approve one visit a month. This child was self-injuring earlier this year, and is coping now only due to expanded IEP accommodations and weekly psychotherapy. They are not following the rules on the appeals process, and are dragging their feet as much as they can and 'losing' needed information and our documentation, which further delays the appeal. It's truly appalling. We are now paying out of pocket for the absolutely needed weekly visits.

They also are restricting access to a kidney transplant needed by another family member. They have their own 'managed care' that those needing any transplants are required to use. The reality is that they use it to restrict access to care by being very slow to approve tests, slow to respond to phone calls from the transplant hospital and related medical team, and only paying for transplants at a very limited number of transplant centers (many of those that they will cover have transplant list wait times that are years longer than those at 'disallowed' transplant centers.) NALC pays NOTHING for going 'out of network' for an organ transplant. Rather than wait an extra 2-5 years for a kidney transplant, we'll move to BCBS and try for a transplant at a hospital with a shorter expected wait time.

So, the issues that we are facing with NALC may not be related to your family's needs, but be aware that NALC may cause problems for your family's health care if providing coverage suddenly becomes expensive for them.

Frist, I am sorry that your family is going through all of these medical issues. Second, thankyou for laying out the problems you have had with such detail, it is very enlightening.

[Anonymous]

48-year-old female cancer patient here and I love Kaiser. I used their online system to research oncologists & other specialists, and I'm very satisfied now that I'm two years out of treatment. I had chemo and radiation (Kaiser authorizes outside rads because they don't offer that treatment) and am extremely pleased with my care.

One thing not everyone realizes is that you can go to any of the Kaiser centers & therefore select any of the doctors. My oncologist is at Shady Grove, my gynecologist is at Kensington, my surgeon is at Largo, and so on.

There's no substitute for the ease of access and information.

[Anonymous]

Family with DS with serious medical issues. BCBS Standard has been the best for our family for many years. Would not change to another. Little hassle and lots of choice.