I'm a new federal employee overwhelmed by the number of options we have for health insurance. My former employer only had one carrier and two flavors of HDHP to pick from. I have Crohn's Disease which requires I be on a biologic, see a specialist once or twice a year, and either have a colonoscopy or pill endoscopy every few years. My Crohn's is well managed and I wish to keep it that way. I'm pretty healthy outside of the Crohn's diagnosis.
I used to be on Humira, but once biosimilars came out, I was moved to Yusimry (I got this from Mark Cuban's Cost Plus Drugs website). One massive perk of my old insurance is that Yusimry was 100% free to me. Insurance paid 100% for some reason, so I was not complaining! If I'm not mistaken, there are numerous biosimilars to Humira now, and very few carriers provide for Yusimry. I should be fine with any of the biosimilars on the market.
I need to make my election before the end of this pay period so that my election is effective ASAP. So far I've narrowed it down to a couple of options based on what I've read online and some of my own study:
1. BCBS - Basic. Most expensive of these options, but also seems to have high customer satisfaction. You know what you'll pay when you visit the doctor. From what I gather they tend to be the least amount of hassle in terms of drug coverage, providers who accept it, and you know what you're going to be paying when you walk in the door. Right now my gut is leaning towards this option despite the higher premiums.
2. GEHA - HDHP. This plan has lower premiums + they'll kick in roughly $1,000 to an HSA for me. Downside is of course that if I need expensive testing done (colonoscopy or pill cam) then that could blow through the savings of premium. Another downside I see mentioned online is that their drug coverage isn't great/expensive. I tried looking for information in what they cover, but it was a bit difficult to see what their formulary covers. They definitely do not cover Humira, but I couldn't find what biosimilars they do cover.
3. MHBP - HDHP. This plan I know the least about. Slightly higher deductible, but they also kick in more money to my HSA. Seems to have better prescription coverage terms vs GEHA. I have not dug into this one as much in terms of how well it would work for me with a chronic disease. The plan seems to have good satisfaction based on survey results on the OPM website.
Right now my main concerns are as such in order of importance:
1. Drug coverage. I do not want my insurance company fighting my doctor and trying to move me to cheaper drugs. We've tried cheaper options already and determined biologics work for me. I want Humira or a biosimilar such as Yusimry, which has proven success with me.
2. Ease of use. I do not have time to call insurance and my doctor 20+ times trying to straighten out my coverage nor do I want to fight with them every 6 months in getting authorizations and approvals.
3. Cost. We want to try to limit costs, but this concern is behind coverage and ease of use. If it ultimately costs me $1000 more in premiums, but the experience is painless and less stressful then it's probably worth it to me.
Based on what I've laid out, any thoughts on what plan I should go with? My gut says BCBS - Basic, but I may be tainted by older employee opinions. All of the older people in my office swear by it, but they also admit they never comparison shop.
I used to be on Humira, but once biosimilars came out, I was moved to Yusimry (I got this from Mark Cuban's Cost Plus Drugs website). One massive perk of my old insurance is that Yusimry was 100% free to me. Insurance paid 100% for some reason, so I was not complaining! If I'm not mistaken, there are numerous biosimilars to Humira now, and very few carriers provide for Yusimry. I should be fine with any of the biosimilars on the market.
I need to make my election before the end of this pay period so that my election is effective ASAP. So far I've narrowed it down to a couple of options based on what I've read online and some of my own study:
1. BCBS - Basic. Most expensive of these options, but also seems to have high customer satisfaction. You know what you'll pay when you visit the doctor. From what I gather they tend to be the least amount of hassle in terms of drug coverage, providers who accept it, and you know what you're going to be paying when you walk in the door. Right now my gut is leaning towards this option despite the higher premiums.
2. GEHA - HDHP. This plan has lower premiums + they'll kick in roughly $1,000 to an HSA for me. Downside is of course that if I need expensive testing done (colonoscopy or pill cam) then that could blow through the savings of premium. Another downside I see mentioned online is that their drug coverage isn't great/expensive. I tried looking for information in what they cover, but it was a bit difficult to see what their formulary covers. They definitely do not cover Humira, but I couldn't find what biosimilars they do cover.
3. MHBP - HDHP. This plan I know the least about. Slightly higher deductible, but they also kick in more money to my HSA. Seems to have better prescription coverage terms vs GEHA. I have not dug into this one as much in terms of how well it would work for me with a chronic disease. The plan seems to have good satisfaction based on survey results on the OPM website.
Right now my main concerns are as such in order of importance:
1. Drug coverage. I do not want my insurance company fighting my doctor and trying to move me to cheaper drugs. We've tried cheaper options already and determined biologics work for me. I want Humira or a biosimilar such as Yusimry, which has proven success with me.
2. Ease of use. I do not have time to call insurance and my doctor 20+ times trying to straighten out my coverage nor do I want to fight with them every 6 months in getting authorizations and approvals.
3. Cost. We want to try to limit costs, but this concern is behind coverage and ease of use. If it ultimately costs me $1000 more in premiums, but the experience is painless and less stressful then it's probably worth it to me.
Based on what I've laid out, any thoughts on what plan I should go with? My gut says BCBS - Basic, but I may be tainted by older employee opinions. All of the older people in my office swear by it, but they also admit they never comparison shop.
Statistics: Posted by ghenghispwn — Wed Jan 29, 2025 7:25 pm — Replies 1 — Views 87