New FEHB Employee? Here’s How to Compare Health Insurance Plans

Congratulations on the new Federal government job! Now that you have landed the job, it is time to choose a Federal Employee Health Benefits (FEHB) plan. With 180 health plan options to choose from, finding a plan can be overwhelming if you don’t know where to start.

To help make the process easier, we put together the top things to consider when comparing FEHB plans.

1. Learn about the network and plan types

A provider network is a list of doctors, other health care providers and hospitals that a plan contracts with to provide medical care to its members. Different health insurance companies have different networks. When evaluating your health plan options, you will want to consider the network of providers that is offered and whether your provider is in that network. To ensure you have access to convenient and quality care, look for a plan with a wide range of providers and facilities close to your home or workplace.

You should also understand whether in- and out-of-network coverage is offered. Different types of plans — such as a preferred provider organization (PPO) or health maintenance organization (HMO) — are designed to meet different needs. Some plan types allow you to use almost any doctor or health care facility, while others limit your choices or charge you more if you use providers outside their network.

And finally, if you travel or spend time overseas — whether for work or leisure — make sure the plan you choose covers your care received outside of the United States.

Evaluate your personal health care needs to decide whether you need a big network or the flexibility to go out of network. How frequently you need specialized care, whether you travel often, live in multiple locations, and whether you can factor the higher cost of out-of-network care into your budget are just a few things to think about.

The Compass Rose Health Plan gives you access to one of the largest nationwide networks of doctors, hospitals and facilities — plus the convenience of telehealth visits.

Learn more about our network and search our provider directories

Looking for a health plan with coverage for out of network care? Consider the High Option Compass Rose Health Plan. Want to lower your costs by staying in network? Consider the Standard Option Compass Rose Health Plan. Both options provide coverage overseas!

2. Review coverage and costs

It is important to carefully assess your healthcare needs and budget to ensure you are choosing the right balance between coverage and costs.  

Consider your medical needs

In the coming year, will you be dealing with any chronic illnesses or planning for an upcoming surgery? Do you or your family members visit the doctor often, or do you have young kids who get sick frequently? At minimum, make sure the plan you choose will cover you and your family’s planned medical needs.

Generally, paying more in your premium can give you access to a higher level of coverage. If you anticipate needing frequent medical services or have a health condition that requires regular doctor visits, medications and specialist care, a high option plan may be ideal.

If you only need basic coverage for routine check-ups and occasional medical visits, a lower level plan can provide sufficient coverage without the higher cost of a more comprehensive plan. A low option plan tends to be a popular option amongst younger individuals just starting their careers who want to save on health insurance costs.

Assess all out-of-pocket costs

Your costs extend beyond your biweekly or monthly premium. It is important to research what you can expect to pay out of pocket, including deductibles, co-pays and coinsurance. Not sure what each of these terms mean and how they factor into your care? Here are helpful definitions of terms commonly associated with health care costs:  

• Copayment (co-pay): a fixed amount you pay for a covered health care service when you receive the service. For example, you may pay a $15 co-pay to see a provider when you are sick or $5 for a generic prescription. Most of the time co-pays apply to services your insurance covers even before you meet your deductible.
• Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage. You typically need to meet your deductible before coinsurance percentages kick in.
• Deductible: What you spend on applicable services before your plan begins to pay.  
• Out-of-pocket maximum: The most you will have to spend for covered services. After you reach your out-of-pocket maximum, your health plan will usually pay for all covered services.  

Learn more about how each of these costs may apply to your plan

These costs can stack up as you use your plan throughout the year. While it is difficult to anticipate all your needs, you should compare costs for provider visits, specialty services, emergency room visits, lab tests, rehabilitation therapies, prescriptions and anything else you may anticipate needing. Check out our plan comparison to compare costs within each of our plan options. Want to compare costs across different FEHB plans? Check out OPM’s plan comparison tool.

3. Check pharmacy benefits

• Find out who the plan’s pharmacy benefit manager is as they play an important role in managing your pharmacy benefits, including the network, formulary, home delivery options and more.  
• Check the plan’s formulary (a list of covered drugs) to make sure your medications are covered. Typically, plans will not cover drugs that are not on the formulary.
• Look at the drug coverage tiers to determine your costs. Plans typically have different coverage levels for generic drugs, preferred brand-name drugs, non-preferred brand-name drugs and specialty medications, each with different costs.
• Ensure there is a network pharmacy location that is convenient and local to you where you can fill prescriptions.  
• Research the availability of mail-order pharmacy services. You may be able to skip the trip to the pharmacy AND lower your out-of-pocket costs.  

Learn more about the Compass Rose Health Plan’s pharmacy benefits

4. Compare complimentary health and wellness programs

Some health insurance plans offer additional programs and services to help keep you healthy beyond your routine doctor visits. Look into what kinds of health and wellness programs are available, like maternity programs, fitness benefits or rewards for completing certain screenings.

Discover the health and wellness programs available under each Compass Rose Health Plan option

Comparing health plans requires a comprehensive approach to ensure you choose the one that best fits your needs and budget. By thoroughly examining the factors above, you can make a well-informed decision.