CalPERS Open Enrollment- The Short Answers

Those of you who are State of California employees, or public employees who use CalPERS for health insurance (such as City of Placerville, Garden Valley Fire Department, El Dorado Irrigation District) have by now received the thick stack of glossy paper presentations on your options for health insurance for 2008.

I've already posted on this several times, and have discussed this with lots of patients, many of whom I have known for up to 10 years. I'm definitely getting the idea that any lengthy discussion larded over with HMO-PPO-EPO-IPA-blah-blah-blah is simply confusing, and that the big package from CalPERS can be overwhelming.

So, in a nutshell, here are the Short Answers to the Frequently Asked Questions:

• How do I keep you as my doctor?
• Choose one of the Blue Cross administered PPO choices: PERS Care, PERS Select, or PERS Choice.

• Are you with PERS Select?
• Yes.

• What is PERS Select?
• It's basically the same benefits as the PERS Choice plan, but where the 20% tier of personal costs goes with seeing doctors who are PERS Select doctors.
• I think these are doctors who Blue Cross feels meet some selective criteria for higher quality of preventive care and treatment of chronic illnesses.

• What are PERS Care and PERS Choice?
• These are brand names for two PPO plans through Blue Cross.

• What's a PPO?
• This is health insurance where you can choose your own doctors and see specialists whenever you want.
  
• Annual physicals are covered.
  
• Coverage of medications is typically better.
  
• There is an annual $500 deductible (this is very low compared to most other people's insurance).
  
• After this, you pay 10% (for PERS Care) or 20% (for PERS Choice or PERS Select) up to the annual max. After that, Blue Cross picks up 100% of medical costs.
• Please notice the annual max: you won't be getting a bill for 10-20% of a million dollars in medical care for a medical catastrophe!
  
• This is basically like the insurance plans that employees of smaller employers (like Intel, Bank of America, Microsoft...) get to pick from only with lower deductibles and lower max. In other words, you are on the hook for less money than most folks.

• Will it be hard to see primary care doctors or specialists?
• No.
• Most doctors take Blue Cross.
• Referrals are not required by the insurance.
  

• Should I pick PERS Care or PERS Choice? What's the difference?
  
• PERS Care has higher premiums every month, but it pays for more of your medical care.
• Most folks with chronic medical problems pick this because they know they're going to fully use it.

• PERS Choice and PERS Select have lower premiums, but pay a lower percentage of costs.
• Most folks who pick these are pretty healthy and don't use their health insurance a lot.
• These can also be a good choice for folks who save money well and want to spend less a month on the premiums since they know that if there's a need, they can manage the annual cap, after which point the insurance picks up everything.

• Can I still be on Blue Shield?
• Yes, but only as an HMO which means all your medical care will be down the hill just like with Kaiser.

• I was told that the Blue Shield EPO will still be available in "certain parts of El Dorado county". Is that true?
• No.
• CalPERS press releases state that your EPO has been dropped completely.
• Blue Shield as an HMO may be available in areas close to the border with Sacramento County.

• What if my employer switches to some other insurance?
• Fine by me.
• Most local large employers are very upset with CalPERS, and looking for insurance that most doctors up here already take. They already have stated at meetings that they don't want people to go to Kaiser because it's far and will result in a lot more missed work because of the drive time involved just to get seen.
• For example, EID is looking at benefits through the Association of California Water Agencies which offers Blue Cross.

• What if I am retired or retiring soon?
• Look closely at what you want to have beyond Medicare Part A and Part B (these cover ER, hospital, doctor visits, labs and X-Rays).
• You could easily be better off choosing PERS Choice because it has the lowest premiums, or even dropping CalPERS altogether.
• Medicare Part D (the drug plan) has an average premium of about $40/month.
• The most expensive Medicare supplement (for additional coverage of things like long-term care) is about $80/month.
  

• I have decided to switch to Kaiser.
• I am very sorry to hear that. You will be missed!