Do Members of Congress pay for health insurance?

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 are a well-insured group, but no more so than the vast majority of government employees who enjoy most of the same benefits as Supreme Court Justices and Senators.

How Much Does Your Senator Pay For Coverage?

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 the employee has selected, but the FEHB can pay up to 75% of the monthly premium depending on the plan. The employee is responsible for the remainder of the cost. Due to the freedom allowed to federal workers in choosing a 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, and 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 Benefit for Members of Congress

One benefit members of congress enjoy that other federal employees do not is visiting the Attending Physician of the US 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, and 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 mixed marriage of government and the open market. Originally conceived as a government-run plan to attract and reward better personnel, the program evolved into a hybrid system due to protest and political pressure. Existing plans created by unions and worker organizations were threatened by an overreaching federal government. So a compromise was struck that grandfathered existing plans into the structure, creating competition guided by consumer demand.

Federal Employees and Health Savings Accounts

Health Savings Accounts (HSA) are becoming more popular in today’s marketplace, in part because of the tax savings these accounts offer. HSA’s, which are tax-free savings accounts for future medical expenses, are only available for policy holders with High Deductible Health Plans (HDHP). In 2012, an income earner will be able to 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 enters 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% 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 healthier, 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. Time will tell if health savings accounts will survive in the changing healthcare marketplace.

The US Office of Personnel Management runs an enormous website which includes most everything about the FEHB program. Designed as an internal resource for government employees, the site is public and can be researched by anyone with internet access. 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.

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