PharmExec Blog

My Healthcare's Better Than Your Healthcare

by Soliant Health

Long before the current debate on health care started, there was a different war brewing. For decades, people have been fighting over which program and plan is best: healthcare provided to government workers, military personnel or civilians?

While this debate will likely continue, it’s time to explore exactly what these health care options entail. By taking a closer look at factors such as eligibility, costs, and limitations on where health care can be received or administered, we’ll have a better understanding of what each type of health care offers.

WHO IS ELIGIBLE FOR WHAT PLAN

Government Workers


Health Care Plan: The Federal Employees Health Benefits Plan

Eligibility: Civilians and the families of those who work in offices associated with the United States government

The Federal Employees Health Benefits Plan is an extensive system of insurance companies that provide benefits to federal and state employees and their families. Different health insurance plans are included in this system as well as varying levels of deductibles, coverage, and premiums. The insurance is provided through a regional health insurance company.

Military Personnel


Health Care Plan: TRICARE

Eligibility: Active duty or retired military personnel and their families, surviving members of military personnel who were harmed or killed while on duty

TRICARE provides health care coverage to military personnel and their families. Three options are available to choose from. They are pay-per-service, flexible health care coverage, and exclusive coverage by military hospitals and health care centers.

Civilians


Health Care Plan: Varies between individually purchased plans or employer-based plans

Eligibility: Anyone who meets the insurance company’s eligibility requirements. Requirements can vary but usually include not having specific pre-existing conditions. Employment-based plans may require working a certain number of hours per week or a certain length of time employed.

Civilians have the opportunity to purchase health care plans directly from an insurance company or may have the option to join an employer-provided insurance plan.

THE COST ASSOCIATED WITH EACH PLAN

Government Workers

Cost for the plan per year: NPR reported hat Defense Secretary Robert Gates said the average federal worker pays about $4,000 for family coverage.

Costs for Premiums: Typically the government employer will pick up two-thirds while the employee is responsible for the other third.

Costs for Co-Pays/Deductibles: Co-pays and deductibles will vary depending upon the plan and can range from flat fees for specific services to a percentage.

While the co-payments and deductibles associated with the Federal Employees Health Plan may vary, the real benefit comes in the amount of money the employer puts up for the insurance. Two-thirds of the cost is paid for by the federal or state government, and the employee is responsible for only the remaining one-third and any costs associated with their specific health care needs.

Military Personnel

Cost for the plan per year: Gates also said the cost for Tricare for a family is $460.

Costs for Premiums: Depends on which of the three plans are chosen and ranges from an annual enrollment fee to $0.

Costs for Co-Pays/Deductibles: Depends on the plan. Costs can range from a flat service fee where the difference is picked up by the patient, to no out-of-pocket costs for attending a military hospital or provider.

The military’s TRICARE plan has a variety of options that can meet the needs of the servicemen and women. The military will cover the cost of the health care except in cases where there is an enrollment fee. Fees for services rendered such as office visits, hospital stays and prescriptions will vary depending upon which plan is selected and can range from costing virtually nothing to having to pay if the visit goes over a set fee.

Civilians

Cost for the plan per year: In 2009, the average cost of health care per person was $7,960, according to PBS.

Costs for Premiums: Whether you have employer-based or self-paid health insurance, the premiums a civilian pays will vary from 0 to 100% of the overall cost.

Costs for Co-Pays/Deductibles: Varies depending upon the selected plan and can range from flat rates, 100% of the fees covered for high premium plans or paying a percentage of the health care costs.

Civilians have a wide selection of health plans available. They can choose to buy into high premium plans where the out-of-pocket health care costs will be extremely low or they can select plans where they pay per service, or a percentage of the health care costs. In some cases once the deductible has been met there are no out-of-pocket expenses but this depends on the plan and insurance company.

LIMITATIONS ON WHERE HEALTHCARE CAN BE RECEIVED

Government Workers

Health Care Options: Flexible options of in-network and out-of-network doctors.

Government workers have very flexible health care insurance options. The Federal Employees Health Plan allows them to select doctors within the network for a lower rate. Should they choose to go out-of-network for a doctor or specialist, they pay the difference in price.

Military Personnel

Health Care Options: Flexible in-network or out-of-network doctors, or a strict network with a health care manager.

With TRICARE, military personnel have an opportunity to choose where they receive their health care. The Prime option of TRICARE only covers visits to approved civilian health centers or military treatment facilities while the Standard option offers freedom to choose a doctor or specialist and pay only the difference in fees.

Civilians

Health Care Options: Varies depending on plan and insurance company.

The civilian plans include a variety of options on where to receive health care. Some plans will only cover visits to in-network doctors or hospitals, while others allow a more flexible choice. When it comes to seeing a specialist, some plans require a referral while others allow self-referral and still cover the cost.

Conclusion

There are so many different types of health care offered that it’s difficult to pinpoint which one is superior. However, consumer surveys have been done to evaluate who’s happy with their health care providers and coverage. For example, the Army Times reported that the National Committee for Quality Assurance gave the Uniformed Services Family Health Plan an 87% satisfaction rating in 2006 (22 percentage points higher than the national average).

Furthermore, survey results from the polled Federal Employees Health Benefit users are available online, broken down by type of plan and location. The responses consist of above average, average, and below average. You can find the 2005 results here. As you can see, a lot of the satisfaction and overall happiness with any type plan comes down to the specifics, which is probably why it’s been difficult to call any certain type of insurance a clear winner.

Soliant Health is a healthcare staffing agency.

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