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Fedjobplz  
#1 Posted : Thursday, July 21, 2016 3:33:25 AM(UTC)
Fedjobplz

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Hello!

I am currently under BC/BS policy under my parent's policy as dependent and my wife has her own insurance.

But my wife's insurance is ending next month so I need to get my own insurance to have my wife as dependent.

I was doing some research and narrowed it down to Aetna, Kaiser, and GEHA since they have lower premiums than other policies. But after reading some reviews I found out that we should stay away from them because they are basically garbage and we are going to end up paying more if we ever get sick or wait weeks to see a doctor or specialist.

So we decided that we should look into BC/BS even though we will end up paying more since I never had problem getting a care I need when I was under my parent's policy.

But I was confused with BC/BS and Carefirst Bluechoice. I mean I understand Carefirst is HMO and BC/BS is FFS. But people refer them both as BC/BS online. And even though Carefirst is HMO, I was told that I do not need any referral what so ever to see any doctors I want in the area. Is this true?

I hate the idea of going to PCP and get referrals to see a specialist. But it would be nice to save $30+ a month in premium to get Carefirst instead of BC/BS if they are basically the same thing.

Does anyone around DC area have Carefirst insurance and could help me out by giving me some reviews?

Or am I missing out on other great insurance policies?

Thank you guys in advance.

FarmGirl  
#2 Posted : Thursday, July 21, 2016 11:08:48 AM(UTC)
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We aren't covered by FEHB yet (hopefully soon!), but have had at least 6 different insurance plans over the last 15 years that we've lived in the DC Metro area. Various plans with Carefirst, Aetna, & Cigna and haven't found much difference between any of them in terms of coverage or service. We been covered by both a Carefirst HMO and PPO at one time or another and neither plan required referrals to see specialists. With an HMO, coverage is only for in-network providers (PPO will cover them, but you will pay a higher co-pay) and your out of area coverage is usually limited to emergencies only. We never encountered either of those issues so those things really didn't matter.

Everyone I know that has Kaiser in the DC area loves it. We don't consider it because we have established relationships with other providers and would rather keep that continuity than switch.

Have you considered a High Deductible Plan? If you are both healthy (no chronic conditions that require meds or frequent follow-ups) this might be an overall less expensive option for you. We have had one for 5+ years (both Aetna and Carefirst and both were very similar) and have found them to make the most sense for our needs. Preventative visits are still covered 100%, so the only time we pay out of pocket is for specialist or sick visits. Even with one kid seeing an ophthalmologist twice a year and the other seeing an allergist twice a year plus a handful of sick or urgent care visits and some prescriptions here and there, if we compare the premiums + out of pockets, we spend less annually than we would if we had a non-HD plan. We took the half the difference in monthly premiums between a HDHP and traditional plan and put that money into an HSA (which you then can use to pay for those out of pocket expenses) for a few years and built it up enough that we can no longer need to contribute to that (employer continues to also contribute a little on a monthly basis anyway, and I believe the feds do this too?) but have enough there to pay for out of pockets expenses up to and well beyond our "high deductible" and more if needed. And that difference can now go to other saving or spending needs.

Hope that helps? Or maybe adds more confusion?

Good luck!
thanks 1 user thanked FarmGirl for this useful post.
thalweg on 7/23/2016(UTC)
Fedjobplz  
#3 Posted : Thursday, July 21, 2016 11:51:10 AM(UTC)
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Thank you for your reply!

I am going to double check with them before I enroll but I guess I am leaning toward Bluechoice more since they don't require referrals.

We thought about HDHP but we are currently a single GS-7 income family in Maryland-DC area so putting money aside is very hard for us to do with our tight budget and HDHP plans are like $10 cheaper per month.

I was really thinking about Kaiser since their facility is like 5 min away from home. But my colleague told me he had to wait at least a month to see a specialist since it would take him two weeks to see his PCP then wait for referral then wait another two weeks to see a specialist. And reviews are just crap for both Aetna and Kaiser. I mean there are crap reviews for BC/BS and BlueChoice too, but more positive reviews then other insurances.

I still got a month to think about but I wish this was easy as just picking a shirt but once we decide, we would be stuck till open enrollment period and its almost $300 per months.

I mean I know that these options are usually better than what other people get because we were actually thinking about buying insurance only for her through Marylandhealthfinder but was shock how expensive it was with worse coverage.

Again, thank you for your reply!

GSBS  
#4 Posted : Saturday, July 23, 2016 12:44:36 PM(UTC)

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Don't make any changes just yet as I'm not sure you can outside of open season in this situation?

https://www.opm.gov/reti...ms/pamphlets/ri75-13.pdf
Fedjobplz  
#5 Posted : Saturday, July 23, 2016 3:36:26 PM(UTC)
Fedjobplz

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I have checked with HR. Since my wife is losing her insurance policy, it qualifies as QLE for us to start enrollment outside of open season.
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