MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, Your Turn on cellphone etiquette. Whether talking or silently texting, is smartphone usage OK any place, any time? But first, 8 million people are enrolled in the federal employees' health benefits program. All of them can switch their plan right now, and most would save a cool grand if they did. But only about 40,000 will make a change before open season ends on Monday.

MR. KOJO NNAMDIMore might, but there's work to catch up on after Thanksgiving, that tree to trim and, let's face it, about a zillion other things you'd rather spend a few hours doing instead of poring over health care brochures. But it doesn't have to be painful, and you've still got some time. Here to help us out, Walt Francis is the author of the Consumer Checkbook 2012 Guide to Health Plans for Federal Employees. Walt has been doing this for over three decades. Walt Francis, good to see you again.

MR. WALT FRANCISNice to see you, Kojo.

NNAMDIAlso with us in studio is Robert Krughoff. He is the founder and president of Washington Consumers' Checkbook magazine. Bob Krughoff, good to see you again.

MR. ROBERT KRUGHOFFGood to see you, Kojo.

NNAMDIAnd you can join the conversation at 800-433-8850. If you've got questions about open enrollment, we've got answers. Give us a call, 800-433-8850. Or go to our website, kojoshow.org, ask your question there, or send us email to kojo@wamu.org, or shoot a tweet -- shoot us a tweet, @kojoshow. Walt, a lot of people might be thinking that coverage is fine and that the money they'd save by making a switch isn't worth the time it would take to pick a new plan. How much money do people stand to save?

FRANCISThousands. Thousands.

NNAMDISounds good.

FRANCISI mean, most people maybe aren't in the save $2- or $3,000 range. They may only be in the save $1,000 range. But there are literally a dozen or so plans in the D.C. area, and generally throughout the nation but -- also that are sort of lower price spreads, lower premiums and equally good or better coverage.

NNAMDISo you're talking over $1,000 people can save?

FRANCISYeah, in a year with no -- with the federal pay freeze and no cost living increase, here's a way to give yourself your own cost increase (unintelligible).

NNAMDIEmployees aren't the only ones who save. How much does the federal government save if someone switches to a lower-cost plan?

FRANCISThe government pays up to 75 percent of plan premiums. It's about 73 percent on average. So every time a federal employee makes the smart choice for himself, he's probably saving his employing agency almost as much money or more depending on the premium share of total costs. And some agencies, realizing this, actually purchase the online guide for their employees, giving them free access because they save a ton of money.

NNAMDIThe savings would be great anytime, but with a pay freeze in place, switching plans may be the only way for federal employees to see some extra money in their paycheck over the coming year.

FRANCISThat's right. It's a Christmas present and an end-of-year bonus and all the rest and a cost-of-living increase all rolled into one.

NNAMDISo if you're thinking about switching but don't know exactly what you want to go for, call us, 800-433-8850. Bob Krughoff, people are sometimes reluctant to switch plans because they're worried that amazing doctor they finally found on their current plan won't take their new insurance, but you have a fix of sorts for that dilemma.

KRUGHOFFYes. For the first time this year, we actually have a government-wide or, you know, all-plan doctor directory, so when you go in there and you start looking -- when you go onto our website, which is guidetohealthplans.org, you go on there, and you sort the plans. In fact, they come up automatically sorted by cost, which is your premium plus your good estimate of your out-of-pocket costs.

KRUGHOFFThen, if you -- there was a place for you to put your doctor name in or several doctors' names in, it shows right next to that cost figure for each of these plans, does the plan -- have your doctor -- does your doctor participate in that plan, your one doctor, two doctors, three doctors, are they in that plan? So that's very good. If you do have a doctor, we also have a directory of doctors across all the plans also that indicates which doctors are really high-quality doctors based on a number of different measures.

KRUGHOFFSo it's easy to choose a doctor, and it's also easy immediately to see as you look at these different plans. Is my doctor in them?

NNAMDIWhat are some of the basic expectations that patients should have of their doctors, regardless of what kind of coverage they have?

KRUGHOFFWell, first thing, for a primary care doctor, or all doctors, but, really, primary care doctors, your main doctor, you want to make sure the doctor listens to you, the doctor explains things in a way you can understand, the doctor is familiar with your case, finds out what's happened if you've seen a specialist, et cetera. That kind of communication, that kind of coordination is a very big deal. As you know, I think we've talked before about surveys we have done, which we've done in various parts of the country, surveying patients about doctors where we ask them just that kind of question.

KRUGHOFFThere are a lot of other things you want to know about...

NNAMDIOf course, there's always the relationship between the time of the appointment and the time you actually see the doctor.

KRUGHOFFYes. And that's right, and that's something we look at, too. And on the -- and another thing we've done in this guide this time is had even more information on the quality of plans where people are rating their plans in terms of the choice of doctor. We made a lot of improvements this year in the guide with two things in mind. One thing, we're always trying to improve it.

KRUGHOFFThe other thing is what the federal employees have now is what everybody in the country -- or not -- or at least many people in the country, in all states of the country are going to have, fairly soon, under health reform, which is called health insurance exchanges, where you'll have a choice of a lot of different plans. And they're going to need a plan comparison tool to try and pick out which is the best plan.

KRUGHOFFAnd so we've adapted the tool that we have for federal employees to be available in all of the states around the country to help them make these plan comparison choices, which are otherwise very complicated.

NNAMDIDo you carefully weigh your health plan options at open enrollment time, or do you use the renewal or dart-throw method?

NNAMDICall us at 800-433-8850, especially if you happen to be a federal employee thinking of changing plans at this time. Or you can go to our website, kojoshow.org. Before I go to the phones, Walt, money is not the only factor to take into account. If I'd like a lot of bang for my buck and no hassles about claims, what's my best bet?

FRANCISYou're an HMO customer, and, you know, there are three basic types of plans in this program: the traditional PPO fee for service plans, these new high deductible and consumer-driven plans and the old-fashioned HMOs. And there's a good set of choices available to almost all federal employees in the D.C. area. Some of the very best buys in our plan ratings are plans like Kaiser and Aetna Open Access Basic, and those are the plans where there's no paperwork. There's no claims to process. You don't have to fill out a lot of forms, and you get to pick from a pretty big panel of top doctors.

NNAMDIHow about disputed claims? Do some plans have a better record than others when it comes to the handling of disputed claims?

FRANCISThey sure do. And it's interesting. There's no -- that's another quality measure we have. In this program, people get to appeal to the Office of Personnel Management if they don't think the plan paid something it should have. And we find that there are really wide variations. That's one of our measures of quality among plans. The Blue Cross Blue Shield seems, year in and year out and certainly last year, to lead the pack in its -- that measure of customer satisfaction.

FRANCISBut the SAMBA plan, which has a pretty good buy in the standard option, rural carrier plan -- not much use to the D.C. area. You've got to be a rural postal employee -- but -- and the GEHA plan, those are among the best in those ratings.

KRUGHOFFOne of the things...

NNAMDIGo ahead, Robert.

KRUGHOFFOne of the things we've done in this guide, we've always given member ratings of plans based on independent surveys of members of the plans. We have also this time given detailed information on whether the doctors in the plans, on average, are giving people the tests and treatments they should have. So if you have diabetes, are they giving you a hemoglobin A1c test, et cetera? Do people get those tests done so the quality of care you're getting in the plan -- and then also this disputed claims hassle-type stuff in the plan, so -- and different people will care about different things.

KRUGHOFFSome are more worried about those claims problems than they are about the quality of the doctors or whatever, and some, just the reverse.

NNAMDIYeah, because one size doesn't fit all, so you're saying now that visitors to your website can choose to sort of skew the ratings based on their particular circumstances.

KRUGHOFFYes. We've actually set it up so there are sliders you can move on the website. You can say, well, this is what really matters most to me. This doesn't matter much at all. And then we give star ratings for quality. But those star ratings will be different for you than they will be for somebody else because you care much more about diabetes care or heart care or cancer care and much less about having a problem with a claims dispute.

NNAMDII want a doctor with good handwriting.

NNAMDIHere is Scott in Falls Church, Va. Scott, you're on the air. Go ahead, please.

SCOTTHi. Yeah, my name is Scott calling from Falls Church. I have Blue Cross Blue Shield, now the basic option PPO. It seems to be working great, especially for the physical therapist I see, which is in my plan. The problem is I had to see an outside physical therapist, but I had to pay cash for it. And my plan doesn't cover that outside out-of-network physical therapy at all. I had to pay 100 percent of it, which was fine for now.

SCOTTBut I was looking just the other day at some of the other plans. The benefit of my plan seems to be that it does not have a deductible at all, and that I was looking at some of these other things that may hopefully cover part of the out-of-network physical therapist. But I don't know how much they would cover 'cause it seems they depend on what the allowance is, and I had no way of figuring out what the allowance was. And it was just all very complicated.

SCOTTI was wondering if there was a way that these tools could help show versus whether a plan has a deductible or not and how that may work out for you in the end.

KRUGHOFFAbsolutely. We show all the information on -- summary information, I should say, on plan cost sharing features, so the plan -- you can look at the table that shows which plans have deductibles, and if so, how large they are, whether there's an extra hospital deductible, whether they cover out-of-network providers or not. All the national plans, except the one you're in -- Blue Cross basic -- do let you go out of network. So, yeah, our -- and our ratings take all these into account in various ways, so, yeah, by all means, try the tool.

KRUGHOFFBut let me just, on the air, tell you, you might check out one or two other of the low-cost national plans that do cover out-of-network care, such as GEHA standard option. And what you can do is talk to your therapist about whether he or she participates in that plan. OK? Or, you know, we cover doctors in our -- we show which doctors participate, but we don't have all health care providers yet. That may be coming next year.

NNAMDIThank you very much for your call, Scott...

SCOTTThank you.

NNAMDI...and good luck to you. Here is Alberto in Germantown, Md. Alberto, your turn, you're on the air. Go ahead, please.

ALBERTOGentlemen, thank you very much. I -- my wife and I (unintelligible) we have the Blue Cross Blue Shield at the high option, and we're looking into changing to something else than we've got now. We're in the mid-50s and so wondering what the -- off the cuff, you could suggest I could -- do we need any (unintelligible) Monday.

KRUGHOFFSure. By the way, background for those who don't know, the Blue Cross standard option, which is a great plan, is very expensive. It's got for a family the premium is over $5,000 next year, OK? So plans that we count -- and remember, we take into account both the premium and your likely out-of-pocket costs, and even some not-so-likely out-of-pocket costs, but some of the plans we rate really highly that are likely to save you a couple of thousand bucks next year, among the HMOs: Kaiser Standard, CareFirst, BlueChoice, High Option, Aetna Open Access Basic.

KRUGHOFFAlmost all the consumer-driven and high-deductible plans -- and these are a different kind of cat -- but they are all really good buys. Among the national plans, most comparable to what you're in, the obvious choice is Blue Cross Basic. If you will -- if you like Blue Cross, if your doctors prefer the Blue Cross, and you're willing to kind of be careful not to go out of network, except on a rare and inexpensive occasion, Blue Cross basic is a great choice. Foreign Service, if you're eligible. APWU High Option is another good one. That's the American Postal Workers Union plan, but anybody can join it.

KRUGHOFFAnd GEHA Standard Option. So, yeah, you've got several very good choices to explore.

NNAMDIAlberto, thank you very much for your call. Walt, the Affordable Care Act, better known as Health Care Reform, has already brought some changes to plans. What else is on the immediate horizon?

FRANCISVery little. There will be a -- this year, no significant change.

KRUGHOFFYou're talking about within the federal system.

FRANCISWithin, yeah, affecting federal employees.

KRUGHOFFYeah.

NNAMDISure, sure, sure.

FRANCISI mean, for example, at the age 26, your child, up to age 26, coverage is already in.

NNAMDIThat's already in place. Yep.

FRANCISFree annual physical and routine vaccinations and so on. That's already covered in all...

NNAMDIFlexible spending accounts?

FRANCISFlexible spending accounts are already available to federal employees. Just they weren't added by the -- by health reform.

NNAMDIBut it's my understanding that they have some new restrictions on them?

FRANCISOh, well, there's two -- there's a restriction already in place about over-the-counter drugs, unless prescribed by a doctor, which is a weird combination, so that you won't be able to pay for aspirin out of your flexible spending account anymore. But -- and a year or two down the road, the total amount you can set aside will go down from $5,000 to $2,500. But, by the way, most federal employees are such couch potatoes that they don't sign up for a flexible spending accounts during open season.

FRANCISAnd they can save you a lot of money 'cause it's a way to shelter, from all taxes, money that you know you're going to spend next year on co-payments, deductibles and everything else that you might use, except over-the-counter drugs.

NNAMDII can testify. But, Robert Krughoff, the clock is ticking down on the time people have left to spend their FSA money as well, right?

KRUGHOFFWell, that depends on the annual basis that your FSA money is in. For instance, in our organization, our FSA goes from July 1 to June 30. So you really need to figure that out. (unintelligible)...

FRANCISOh, but the federal one is January to January, except there's about a 2 1/2 month grace period. So if you don't spend it all by New Year's Eve, you know, that pair of eyeglasses...

NNAMDII was about to say, hurry up and get that pair of eyeglasses.

FRANCISYou got another month or two. But, yeah, the people should be careful to have an FSA account, but not put too much money in it 'cause you'll lose what you don't spend.

NNAMDIWe've got to take a short break. When we come back, we'll continue our conversation on health care open enrollment for federal employees. You can call us at 800-433-8850. If you've already made your health care enrollment decisions, what did you decide to change, if anything and why? 800-433-8850. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation about federal employees health care open enrollment. We're talking with Robert Krughoff. He is the founder and president of Washington Consumers' Checkbook magazine. Walt Francis is the author of the "Consumer Checkbook 2012 Guide to Health Plans for Federal Employees." And we're taking your calls at 800-433-8850. We talked about FSAs, flexible spending accounts, Walt. But what's the difference between an FSA and a health savings account?

FRANCISPretty substantial. The FSA is you set aside money for your out-of-pocket costs. And it's use or lose money -- the end of the year, it goes poof. Health savings accounts are quite different. The money -- you have to be in a high deductible health plan, OK, so you can use your health savings account to pay for up to -- depending on the plan, a couple thousand dollars of expenses. And then there's a big -- another -- a deductible that kicks in, a couple of thousand dollars, and then regular insurance kicks in. All those plans have low premiums and very good coverage of insurance and catastrophic cost.

FRANCISThe key, though, the health savings account, it is not use-or-lose money, and it's in your title. It's sort of like an IRA on steroids. The money goes in tax-free. It can grow over the years tax-free. You can take it out tax-free. And if you're -- you know, if you, in some later year, have a bad year, you can use some fraction of your health savings account to pay for that deductible out-of-pocket area. And then insurance kicks in, and your HSA continues to grow and thrive. Anybody who hasn't at least thought about and looked at one of the FEHBP High Deductible Plans is missing a great opportunity.

NNAMDIAnd, of course, you can find a link to the Washington Consumers' Checkbook website at our website, kojoshow.org, where you'll be able to find a lot of the information we're talking about today. Robert Krughoff, how do you do the cost comparisons that you do about these health plans?

KRUGHOFFWell, I think it's very important that people know we're not -- and they should not be -- looking only at premiums. In fact, we have examples in here where a couple of the -- particularly one of the lowest premium plans -- I think it's the lowest premium plan. If you actually estimate how much it's likely the cost a family like yours next year, it might turn out to be one of the highest cost plans. And so we look at premiums, plus an estimate of out-of-pocket cost for a family like yours, so a family of your age, family of your family size, et cetera.

KRUGHOFFAnd we do that based on national data about how much people end up spending. But we also tell you, what would happen in a very bad year and which of these plans would be most expensive in a very bad year? And some of them are $10,000 more expensive than others in a very bad year. And we tell you the probability of having, you know, such a very bad year. So those are all -- all those things affect your out-of-pocket cost. And I just want to stress that the thinking about your out-of-pocket cost in this way is critical to choosing a plan that will actually be a good deal for you.

NNAMDIHere now is Dick in Silver Spring, Md. Dick, you're on the air. Go ahead, please.

DICKYes. My wife and I are both on the Medicare Part A and Part B. And we also have the federal employee plan, the Blue Cross standard option, but we're thinking of switching to the basic option. And I know that the basic option covers only -- as far as physicians are concerned, covers only preferred providers. What if you had a provider who was not in the network, but who did accept Medicare? What would we have to pay?

FRANCISThat -- the beauty of what you're talking about doing is -- let me say first, you're making a great decision, I think, a wise decision. What you -- what you're going to do in effect is use Medicare Part B to pay for your out-of-network physicians. And you'll get the -- of course, they have to take the Medicare rate. Medicare pays 80 percent of that.

FRANCISSo you'll just be paying 20 percent of the physician's charge if you use a non-network provider. So you could have the advantages of Blue Cross Basic's network of preferred providers -- it's low premium. It's very good coverage -- and use Medicare, basically, as a wraparound. Actually, technically, it pays first. I want to, though, mention that, while that's a good choice, that is the one national plan that doesn't offer you a complete wraparound so that you get paid 100 percent no matter what doctor you use in or out of network when you have parts A and B. But it's still a very good choice.

NNAMDIWell, couple of other questions about Medicare. And, Dick, thank you for your call. We got an email from Patsy, who says, "Although I'm 68, I still work full-time for a nonprofit and have health insurance. However, the cost has risen tremendously, and I'm considering going on Medicare Plan B. I did sign up for Plan A when I was 65. Can I sign up for Plan B at any time? I tried looking at advantage plans, but for a Maryland resident, there aren't that many. Florida has a lot. The Medicare website frustrated me.

NNAMDI"Will it be helpful to go to Social Security in, in this case, Rockville? Any advice? The more the better."

FRANCISOK. Yeah. She could sign up -- there may be -- she may not be able to do it until next spring. OK. But, basically -- and the regular Medicare open season just ended a couple of days ago.

NNAMDIYep.

FRANCISSo I can't -- that's a technical detail. But some time in the next few months, she'll be able to sign up for Medicare Part B. Normally, when you're still working and covered by other insurance, you don't want to pay the Part B premium because Part B is what's called secondary. And it never pays hardly a dime over and above what your regular insurance pays. But in her case, if the insurance is costing her an arm and a leg, I think it's very wise to go to Medicare Part B. With parts A and B, you can -- you don't have to have a Medicare Advantage Plan. There are enough, though, in Maryland.

FRANCISI would take another look at that. But there's also things called Medigap plans, OK, quite a few of them. And so you have a lot of options there. And you'll save, of course. The Medigap plans cost a fair amount of money, but you're likely to save a fair -- you know, depending on exactly what your premium is now. As to where you find the information, calling Social Security is not going to help you. There is a Medicare 800 number. It's 1-800-MEDICARE, as you might think, and they could give you a lot of advice. But they're not really trained or able to compare plans directly.

FRANCISWhat you really want to do is go back to that Medicare plan compare website, which is modeled on an older version of our website -- not as good as ours. It's -- but it's really very good. It's a little bit slower and frustrating, I understand. Try it again. Maybe have a friend sit down with you, and I think you'll -- and it does use our method of rating plans. It'll tell you which ones, taking account premium and out-of pocket, are good buys.

NNAMDISpeaking of Medicare, we got this email from Cindy. "When retiring, is it best to keep your existing health care and either make Medicare secondary or not use Medicare at all, or to make Medicare primary and using our existing health care as secondary? We're concerned about the future of Medicare. I'm very happy with our current plan, so we lean towards keeping it as our health care plan."

FRANCISThat's a great question. As I like to say to people, that wonderful plan you were in at age 64, it didn't change, like, you know, into something terrible at age 65. You do not need to take Medicare Part B. It cost about $100 a month next year. It has some advantages like letting you go out of network, as I just mentioned earlier. But, you know, for two people, that's $2,400 in premium. So think -- there are some pros and cons. Obviously, you're -- I like to call political insurance -- what you're thinking about -- what bad evil deed might the Congress do.

FRANCISBut, yeah, they can do something bad that you have to actually pay, too. So there's a plus to having both programs in that respect. But, no, there's no -- and let me just add, if, in a future year, you decide you really wanted part B, there's a 10 percent a year penalty. But you can sign up again in the future if some particular reason comes up.

NNAMDIAnd, Robert Krughoff, you would be particularly interested in the latter part of Cindy's email. Also, Cindy writes, "I'm sorry to report that we are retiring and leaving the D.C. area, and Checkbook will be one of the services we will miss the most. I have relied on it for all our years and can't -- for all your years and can't imagine how I will check out services without it." It looks like you've got to expand your horizons, Robert.

KRUGHOFFThank you very much, Cindy. It's nice for you to say that.

NNAMDIAll right, on to the phones again. Here is Shay (sp?) in Columbia Heights. Shay, you're on the air. Go ahead, please.

SHAYYes. I'd like to know if there are any plans that actually smile upon chiropractic or any other alternative medicines or methods.

FRANCISSure. That's...

SHAYAnd, secondly, what's the best plan that has a good dental coverage for major surgery, et cetera?

NNAMDIWe haven't gotten to dental yet, but go ahead, please.

FRANCISAll right. Let me first say our guide does compare plans in lots of ways. One of them is we tell you which plans provide various coverages that -- such as chiropractic. Acupuncture is another one, and there certainly are a number of plans that provide some coverage, not usually great coverage, but, you know, just, you know, if you need 20 visits, you know, or something like that, you're likely to get most of it paid. Dental is a whole other complex arena.

FRANCISWe rate all the plans for their dental coverage, and we rate the stand-alone dental plans that federal employees have access to. And so we -- and we give you a very -- we actually estimate the out-of-pocket and premium cost for dental plans as well. And there are some good buys. But I got to warn you that the dental plans pay typically 100 percent of your, you know, check up, your annual, you know, having your teeth cleaned and that kind of thing. And they pay very well for low cost procedures, like having a filling.

FRANCISBut if you need crowns or bridges or anything, root canal, something very expensive, you are probably going to pay over half the cost. That said, if your dentist is a member of the network of the dental plan, you get the network rate. So it's -- it can save you a lot of money. So my recommendation is you -- right away, 'cause you only got a few days left, call your dentist's office. Find out what dental plans they're in, if any. A lot of dentists are in several of them. And then take a quick -- go either to our website or to the OPM website.

FRANCISLet me mention. That's opm.gov/insure, and it's a very good federal website. At either place, you can look at plan brochures and compare one or two plans side by side and get a lively sense of what -- how you'd like it to fare next year.

NNAMDIThis also covers vision plans as well, correct?

FRANCISCorrect. Vision plans, they cost the order of $100 a year for one person, and basically, you're getting a free pair of eye glasses or free pair of contact lenses. Some people, that matters a lot. Others will say (word?). I've -- Checkbook actually rates places that sell glasses and has found that the discounts you can get in some places are actually saving you more money than these vision plans do.

NNAMDIHere is Rob in Rosedale in Washington, D.C. Rob, your turn.

ROBHello. Yes, can you hear me?

NNAMDIYes, we can.

ROBYes. I'm a big fan and user of the Washington Checkbook, and actually I was just using it earlier before the show, so thank you for all the great work. We recently switched over last year to the National Association of Letter Carriers plan, the NALC. And I noticed there are some other plans with similar names of mail carriers. My question is, given the problems that the postal office is having, is there any words of wisdom or warning that we should take into account whether we want to renew it with the -- which we're very happy with the plan.

ROBBut given all the problems with the postal office, is there any likelihood in the next year these plans could be affected by the Congressional debate over the future of the postal office?

FRANCISI think that in the next year, you're absolutely safe, and I wouldn't let it be a factor in your decision. Stick with NALC plan. It's a good plan. It's a good choice. I'm involved in that postal debate. The postal service is -- which needs money badly. It's on the verge of insolvency -- is trying to get its hands on close to $70 billion in taxpayer subsidies from funds set aside for health insurance of future retirees. I don't think they're going to get that, and I don't think they're going to pull out of the FEHBP.

NNAMDIRob, thank you very much for your call.

ROBThank you.

NNAMDIOn to Linda in Woodbridge, Va. Linda, you're on the air. Go ahead, please.

LINDAHi. Thanks for taking my call. I have just a couple of questions. One is Medicare advantage plans. Feds can suspend FEHB coverage and enroll in Medicare Advantage, of course, when they're eligible to get Medicare. And so I wondered if your guests had any advice about that. And also when one person in a couple is -- and they have a self-family plan -- is eligible for Medicare and the other person isn't, and there are children involved under the age of 26, so they would have to be covered under self and family, too, do your guests have any advice about plan selection in those instances?

FRANCISSure. First, if you have to have self and family coverage for one of the reasons you -- like you have children that you have to cover, then it's probably not a good year to switch to a Medicare Advantage plan. That said, a few years down the road when both husband and wife have Medicare parts A and B and the children are past the age of 26, it is actually one of the most cost saving options available. And what people can do is suspend, not cancel -- never cancel your federal employee coverage. Suspend it. You actually arrange it with OPM.

FRANCISAnd the Medicare Advantage plans have gotten better in the last two years. They now all have catastrophic protection, so I think that's an excellent option for people to consider 'cause, that way, you wind up paying one premium instead of two sets of premiums. But that's for next year. Your Medicare open season is over. It ended Dec. 7, so -- but keep it in mind.

NNAMDIThank you very much for your call, Linda. You, too, can call us at 800-433-8850 as we continue our conversation about open enrollment in health care insurance plans for federal employees. You can also go to our website, kojoshow.org, and ask a question there. Ever wish you had made a different choice than you did during open enrollment? Why or why not? Or have you already switched to a new plan, and what made you decide to do so? 800-433-8850 or send us a tweet, @kojoshow. I'm Kojo Nnamdi.

NNAMDIWelcome back. It's open season for health care insurance for federal employees, at least up until Monday. And we've invited into our studio, Robert Krughoff, founder and president of Washington Consumers' Checkbook magazine, and Walt Francis, author of the "Consumer Checkbook 2012 Guide to Health Plans for Federal Employees." Walt has been doing this for over three decades.

NNAMDII'll start with an email we got from Anthony, Bob. "Does your guest have any advice," writes Anthony, "for the young, healthy and single? I go to the doctor for my yearly physical and my dentist for my cleaning. I use little else. Am I getting robbed? What other options do you suggest?"

KRUGHOFFWell, people have to be aware that you're buying insurance, in part, for the things you can predict next year. But you're also buying insurance, much more importantly, for the things you can't predict: the auto accident you might be in, the tree you might fall out of or the disease you might contract. And that's what we have in mind also when we compare cost. It's not just the premiums, and it's not just the expenses that you know you're going to have. It's how well they'll cover you if things really go bad.

KRUGHOFFAnd we find that some of these plans are very good if you have those bad years, and some are not very good. And so we're tying to compare these plans on that basis. One of the problems is, you know, we do see, you know, there's the -- there are beginnings out there in the world of what we call health plan comparison tools that needs exchanges that are going to be coming up around the country.

KRUGHOFFThat's one of the reasons we really want to sort of get states around the country to pick up on these concepts that we have in our comparison tool because those types of comparisons are very, very complicated for people. You know, they -- and so they tend to focus on, well, what did I spend last year? That ain't enough. You got to think of -- you got to protect yourself and find a plan that'll protect you well if something bad goes on. You do want to think about what you ordinarily spend. And so we've always tried to do this on our tool. And I think people need that kind of help long term.

NNAMDIWalt, you found a substantial savings if people switched to an HMO from a traditional insurance plan. What do people need to know about how HMOs work before they make their change?

FRANCISWell, they probably need to check out the HMO a little bit, what we have, you know, customer satisfaction ratings and so on. The key thing is that the HMO pretty tightly restricts you to their network. And they may have a substantial network, but you're typically going to have a primary care physician who's going to at least try to be -- manage your care, be the steward of your care. They don't restrict you anymore the way they might have a decade or more ago and let's you now go see a specialist without special permission.

FRANCISA lot of people pick them maybe because of the convenience of that you know the doctors are pre-screened. You know there's no paperwork. And if you're willing to live with some restriction on your choice, why not? The young man that called a minute -- or emailed was wondering what kind of plan what a young single person take. A couple of the HMOs are great bargains in that situation. A lot of people come to Washington as new federal employees, don't want to get the hassle trying to find a doctor and all the rest.

FRANCISJust join an HMO and sort of do that. And the other thing is high-deductible plans, which are sort of the opposite in terms of -- they're the ones where you manage your care actively. So some people like one approach, some the other.

NNAMDIHMOs is what, I think, Arthur in Washington wants to talk about. Arthur, you're on the air. Go ahead, please. Arthur, are you there?

ARTHUR(word?)

NNAMDIArthur, go ahead, please.

NNAMDIExcuse me?

NNAMDIGo ahead, please. You're on the air. We can now hear you.

ARTHURI'm concerned that -- can you hear me?

NNAMDIYes, we can.

ARTHUROK. I'm concerned about this gentleman's push for HMOs. And Kaiser -- I used to work for Kaiser years ago. It was a living hell. People don't realize that HMO primaries have disincentives in giving patient care. They used to have incentives, and those were maybe illegal, fortunately. But primary care is paid the seventh of each month on a -- for their (word?). And then they get a co-pay when they (word?). So the physician has no incentive to see that patient and work them in.

ARTHURAlso, if they refer too many people out, it's going to hold on to the patients too much. If they refer the patients out, they can lose their contract, which can be devastating for them. Also...

NNAMDIYou worked as a physician at Kaiser?

ARTHUROh, I worked for Kaiser, too. This is also about HMOs in general, but also, Kaiser is a terrible, terrible place. You know, it's a sad thing. But it's human nature that if somebody is given incentives, they'll go the extra mile for their patients. And human nature, being what it is, if they don't have incentives, they're just collecting a salary whether they sit there and do nothing or not. They don't go the extra mile.

NNAMDISpeak more specifically, if you will, Arthur, about what you consider the disincentives with HMOs.

ARTHURWell, (unintelligible) well, twofold, one, their pay is (word?) -- set amount every month, whether they see the patients or not, so there's no real financial incentive to see their primary care patients. Actually, to see them is a bother. And the schedules, it takes time. And also, if they need to see a specialist, if they're referred too often, they can lose their own -- they can lose their privileges, lose their contract. But the primary -- really, they're best set up with the point of service plan or a PPO. You just get better care. The physician...

NNAMDIWhat have you found at Washington Consumers' Checkbook, Walt Francis and Robert Krughoff, about HMOs and the incentives or disincentives that they offer?

KRUGHOFFLet me say the incentive problem is a serious problem. But it affects all plans, including PPO plans, OK. Every plan has to figure out how are we going to pay doctors, and it's usually some -- you know, there's a discount because they're going to get an increased volume of patients. But it's not necessarily -- you know, plans sort of calibrate that to try to make it come out. One of the things fee-for-service doctor could do -- the flipside of the problem is you've got a problem, and there are sort of two ways to deal with it, one is buy some drugs, and the other is by going -- having surgery, going to a hospital.

KRUGHOFFWell, guess which one the surgeon is more likely to pick? All right? So these kinds of sort of inherent conflicts are unavoidable in health care. We find that the customer ratings of the people in HMOs tend to be high, if not as high -- actually, young -- they tend to attract disproportionately younger people, OK, who turn out to rate plans a little less highly on average than older people. But some of the plans like Kaiser really attract a very loyal set of users.

FRANCISSo I think he may have had a -- you know, everyone has their own experience and their own preferences, but I would -- I'm not trying to push HMOs over other plan types. I think it's very much an individual choice.

NNAMDIYou can see the comparisons yourself in "Washington Consumers' Checkbook Guide to Health Plans for Federal Employees." We got an email from Susan in Annapolis. "I'm a federal employee and currently have family Blue Cross Blue Shield standard coverage for myself and my husband, who is not a federal employee, but is still employed. We both have Medicare plan A. I plan to retire this spring and continue with my current family plan, but subscribe to plan B. I understand that, when I retire, Medicare becomes my primary insurance. What happens with my husband?"

FRANCISNothing. He won't even notice the difference, actually, for either of you because insurance -- primary means the company pay -- that plan pays first. Secondary is paying second. Typically, that's all behind the scenes. It's not something really visible to you as to who's paying first. So whatever plan you're in now -- is it -- let's assume it's one of those national plans that has the standard deal that all of them but Blue Cross Basic have, which is they give you 100 percent wraparound with Medicare parts A and B for your doctor and hospital bills.

FRANCISIf you see a doctor, you'll pay nothing. If your husband sees the same doctor, he'll probably pay the $30 co-pay or whatever it is that you're both now paying for that kind of visit. So as long as you're in the FEHBP family plan and stay there -- and you never want to leave it. Remember, I mentioned earlier, and there are cases where you can suspend. But suspend means you come back, and you can always come back in a couple of seasons. But leaving aside those kinds of issues, you're fine. These programs work together seamlessly.

NNAMDIHere's Nadia in Fairfax County, Va. Nadia, you're on the air. Go ahead, please.

NADIAHi. Thank you so much for taking my call. I have the Aetna plan. And this year my daughter was diagnosed with autism. We were able to get great, wonderful services for her, including applied behavioral analysis therapy, which is a really intensive service for kids with autism. It is our understanding that Aetna will no longer be covering that service next year, which was incredibly costly. I scoured all of the plan information, and I can't seem to find a plan that will cover ABA services for kids with autism. I wanted to know if your guests have any suggestions.

FRANCISYeah, that's a common kind of problem. I don't mean that autism is common. But the problem of I need a very specialized service, but I don't know which plans cover it. Well, what we recommend people do in those cases, really the most important thing, is talk to the provider or providers who provide that specialized service. Ask them which federal employee health plans best pay for what you're providing. They're likely to know because their patients deal with that problem.

FRANCISAnd if they don't know, maybe you should be looking for a different provider who's sensitive to that kind of issue. That said, there are services that the plans typically do not pay for, and that includes some of the more -- I don't want to say non-mainstream because that's unfair. But, you know, you may find no plan covers very well what you need next year. In that case, I urge you to set up a flexible spending account right now because you can tax shelter the money you know you're going to spend for that particular service.

NNAMDINadia, thank you very much for your call. Another potential big saver you've identified, Walt, are consumer-driven and high-deductible plans. How do they work, and who is the best candidate for such plans?

FRANCISThe best candidate, by the way, is probably the opposite of the person who likes HMOs because you -- the central idea in those plans is you manage your own health care to a much greater degree than in most other health plans. You start the year, basically, with a free physical, if you need it. You then get an amount set aside and either a health savings account or a different kind of account called a health reimbursable arrangement.

FRANCISIn both cases, though, the idea is there's money set aside, and it rolls over year to year. It's not use-it-or-lose. And if you spend in health care more than the amount that's in that account, you then face a high-deductible, which is typically, you know -- both numbers might -- the account might be $1,000, and the deductible might be $1,000 or even more. And for a family, it can be as high as $3,000.

FRANCISAnd then once you -- if you spend -- if you're unlucky enough to have to spend that money out-of-pocket, then regular insurance kicks in. They all have very good catastrophic protection. As we discussed earlier, that's really such an important feature. They are spectacularly good buys for young people who are healthy precisely for that reason because you get the savings account, you could build it up over time, and you get that good catastrophic protection.

FRANCISSo -- but they're also good, it turns out, for middle aged people, too. And there's something called catch-up contributions. And there's -- and everyone is -- also would make extra contributions to that health savings account. So this is the kind of thing. If you don't know how they work, what you do is you get the brochure. One of the plans that offers it, like Aetna, offers both the consumer-driven and the high-deductible plan.

FRANCISAmerican Postal Workers Union has a good consumer-driven plan. GEHA has a high-deductible plan, and so do Mail Handler. So look at one of the brochures for at least one of those plans, and they have very good explanations of how the coverage works.

NNAMDIYou know, you mentioned on the one hand Aetna, which is a name like Kaiser that everybody would know. You mentioned, on the other hand, the American Postal Workers Union, which a lot of people may not know. Robert, talk a little bit about whether or not people who think that they get the best deal with a big-name national company because of the volume of the business they do, they think that's the best place to go. Is that the case? Because I know that Washington Consumers' Checkbook deals with this not only in health insurance plans, but in other areas as well.

KRUGHOFFYeah, we certainly do. And, of course, in many fields, we find that the small independent companies are much better than the large companies. In this case, it's a little more nuanced situation because, for one thing, all the plans that are in this federal program are of substantial size anyway. They're not just mom and pop health plans. And, in addition to that, they, in many cases, are using a network that was put together for -- and is used by various plans. It might be used by some of the other big name plans or whatever.

KRUGHOFFSo their networks of hospitals and physicians, et cetera, may be a very big network that they only -- that they sort of buy into, in a sense. So I think -- we actually find that some of these small plans get rated very high in terms of customer satisfaction. So I wouldn't really worry much about that, although I would, you know, check plan by plan, which is what we're trying to do in the guide, is help you see, well, this one actually doesn't look very good in terms of customer satisfaction and responsiveness and availability of doctors.

KRUGHOFFThis one looks very good. Both of them have names you never heard of before.

NNAMDIThis email we got from Alex in Arlington. "The federal government has been actively recruiting people with significant disabilities for the past few years. Can you address, or does your website account for, the insurance needs of federal employees who have high-cost mobility devices that need to be replaced about every five years, as well as ongoing therapy treatment such as physical and respiratory rehabilitation therapy and often need to see therapists and physicians who are out of network?" That's a lot.

FRANCISThat's a lot. I have a couple of responses. Some of the things you mentioned are things we do cover, for example, speech therapy, you know, how many visits do the plans cover and so on, but I think this is a case we actually have to get in the weeds, in the plan brochures, because wheelchairs, for example, are what are called durable medical equipment. And the plan details on those vary so significantly that, you know, you sort of have to read -- one of the nice things OPM does in managing this program is they require the plans to use a common format in the brochures.

FRANCISSo you can look up durable medical or maternity or whatever and compare two plan pages side by side. So I think this is a case for a little research. The other approach, though, is -- and you can use them in combination -- is to go talk to the purveyors or providers, OK. So if you have your eye on a particular brand, model of wheelchair, well, the people that sell it are going to know which plans pay for it.

NNAMDIWalt Francis. He's the author of the "Consumer Checkbook 2012 Guide to Health Plans for Federal Employees." Walt Francis, good to see you again. Thank you for joining us.

FRANCISThank you.

NNAMDIRobert Krughoff is the founder and president of Washington Consumers' Checkbook magazine. Robert, thank you for joining us.

KRUGHOFFThanks a lot for having us.

NNAMDIAs we said, you can find links to the Washington Consumers' Checkbook website at our website, kojoshow.org. Thank you all for listening. I'm Kojo Nnamdi.