Thursday, March 9, 2017

I want the same healthcare as Congress, or do I?

As the fight heats up in the Capital on the Repeal and Replace of the ACA, there are articles stating that we should get what members of Congress get.

Well, would you be surprised to know that members of Congress, shop in the exchange, just like all other Americans now?

A brief history......  

The Federal Employees Health Benefits (FEHB) Program started back in 1960. Five years PRIOR to Medicaid being enacted, as a matter of fact.  The FEHB was a program that offered over 250 plans in 2010, and about 20 of them offered coverage on a national basis, as opposed to a local or regional HMO.  All employees of the Federal Government were eligible for these programs.  

As of 2014 - members of Congress and their staff were no longer eligible to enroll into the FEHB, they had to enroll into an exchange program, like all other Americans.  A more detailed list of benefits available to Members of Congress can be found here.  

The Federal Government still contributes to the program as their employer, but members must enroll into the Washington DC Exchange Program, DC Health Link.  The average employer contribution is approximately 72%.  But you only get this contribution, if you enroll into the DC Health Link, as part of your federal employment service.  If a member enrolled in any other exchange, in their home state, for example, they get no employer contribution at all.

The DC Health Link program offers coverage, based on age banding - so it costs more as you get older.  For example: I am 47 - a Gold HMO plan for me would cost $589 a month with a total out of pocket maximum of $3500.  If I were 27, the same plan would cost me $376 a month.  

Members of Congress who are over 65 are still eligible for exchange enrollment, unlike all other Americans, or they can purchase Medicare Part B (Outpatient Coverage) and enroll into a Medigap policy in the private market, along with Part D, for prescription coverage.

If you really want get into the Federal Employee Health Benefit program, then demand to get the same coverage all federal employees get EXCEPT members of Congress.




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