What Health Benefits Do Congressmen Receive?

On the campaign trail this week, Democratic presidential hopeful John Kerry touted a plan to give Americans access to the same health coverage that members of Congress enjoy. One of his competitors, Howard Dean, has been pushing a similar proposal. What sort of health benefits do congressmen receive?

Members of Congress are eligible for coverage under the Federal Employees Health Benefits program, administered by the United States Office of Personnel Management. The program covers 8.3 million Americans, from humble bureaucrats to the most powerful presidential appointees. (The commander in chief is also eligible for FEHB coverage, though it’s unclear whether President Bush has opted for such insurance.) In addition, FEHB extends benefits to retirees, spouses, and unmarried dependents under the age of 22; domestic partners are not eligible.

FEHB is renowned for offering its subscribers an unparalleled range of health-care options. In Washington, D.C., for example, federal employees can choose from 19 different plans, ranging from fee-for-service options to health maintenance organizations. Those living outside the Beltway are guaranteed at least a dozen plans to choose from. As the program’s Web site notes, federal employees should consider themselves “fortunate to be able to choose from among many different health plans competing for your business.”

The government’s share of FEHB contributions was fixed in the Balanced Budget Act of 1997. The rule of thumb for congressional staffers and Cabinet members alike is that the government picks up 72 percent of the average premium toward the total cost of a premium—roughly on par with what a generous private-sector employer would offer. The employee pays the remainder via payroll deductions.

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Explainer thanks Mike Tuffin of the American Association of Health Plans.