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Do members of Congress pay for health insurance?

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Keep in mind...
  • The Federal Employees Health Benefits Program allows healthcare providers all across the nation to compete for their members’ business
  • Health Savings Accounts are becoming more popular in today’s marketplace because of the tax savings these accounts offer
  • The FEHB offers several qualifying high-deductible plans for employees who wish to establish health savings accounts

With the current healthcare debate at the forefront of the nation’s budget crisis, some are wondering what kind of health plans are covering our country’s legislators.

Members of Congress have the same health benefits as the vast majority of other government employees.

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How much does your Senator pay for coverage?

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The healthcare options for our federal employees are possibly the most diverse of any segment of the workforce. With an estimated 3 million workers in the federal labor force, the choices available to them can be different in every state.

The Federal Employees Health Benefits Program (FEHB) allows healthcare providers all across the nation to compete for their members’ business.

Since 1960, the FEHB program has allowed competition from health insurance companies, employee associations and labor unions to market health plans directly to federal employees.

Generally, the federal government pays for two-thirds of the plan that an employee has selected, but the FEHB may pay up to 75 percent of the monthly premium depending on the plan.

Employees are responsible for the remainder of the cost. Since federal workers can choose their health plan, monthly premiums can vary widely.

The Congressional Research Service estimates that the FEHB offers around 300 healthcare plans nationwide.

This includes private insurance plans, fee-for-service plans, regional health maintenance organizations (HMO), high-deductible health plans and health savings accounts (HSA).

As of 2009, a Blue Cross and Blue Shield plan would cost over $13,000 annually for family coverage, of which the beneficiary would pay about $360 per month.

Are pre-existing conditions covered for federal employees?

Pre-existing condition exclusions are prohibited by FEHB-approved plans. In addition, there are no waiting periods for new policies.

Contracts are negotiated annually by the FEHB administration with any company that wishes to participate.

The administration also publishes a “satisfaction survey” every year for members to share their experiences with their fellow workers.

Special Healthcare Benefits for Members of Congress

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One benefit members of Congress have that other federal employees don’t is the visiting Attending Physician of the U.S. Congress, along with the Justices of the Supreme Court.

There is an annual fee (around $500) to receive medical services from the Office of the Attending Physician. Services do not include dental, surgery, eyeglasses, or prescriptions.

Members of Congress can also opt for care at any of the nation’s military hospitals.

The FEHB Program is a mix of the government and the open market. Originally conceived as a government-run plan, the program evolved into a hybrid system due to protest and political pressure.

Federal Employees and Health Savings Accounts

Health Savings Accounts (HSA) are becoming more popular in today’s marketplace because of the tax savings these accounts offer.

HSAs are tax-free savings accounts for future medical expenses. They are available for policy holders with High Deductible Health Plans (HDHP). In 2012, the average employee was able set aside up to $6,250 into an HSA and suffer no loss to taxes on that income.

If the worker is over 55, then an additional $1000 will be allowed into the account. There are restrictions to withdrawing money once it’s deposited into the account.

Funds must be approved by the HSA trustee or health insurer in order to be withdrawn. Money spent from the account for anything other than qualified expenses is subject to income tax and a 20 percent penalty.

The FEHB offers several qualifying high-deductible plans for employees who wish to establish health savings accounts. HSA’s are still quite new to the healthcare system, having been introduced into law with President Bush’s signature in 2003.

Some critics argue that wealthier people will abandon the health insurance system, thereby increasing healthcare costs and thinning the risk pool.

The Government Accountability Office reported in 2006 that consumers in a focus group had a mostly positive view of their experiences, but few would recommend HSA’s to all consumers.

Patients with chronic conditions or family members with special needs would be hurt by the high deductible that distinguishes these plans from other health plans.

The U.S. Office of Personnel Management runs an enormous website, which includes most everything about the FEHB program.

Some members of congress have publicly disclosed their health plans, and the USOPM’s website has exhaustive information about every health plan they approve for all to see.

Stop waiting for the right time to compare health insurance plans! Use our FREE online comparison tool and find the affordable health insurance today!

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