A preview of this year’s federal employee health benefits open season

Jared Serbu  All right, Tammy, the time is approaching very quickly here. November 10th is the start of Open Season. Not quite time for folks to be actually registering their decisions yet, but what should we be doing to prepare?

Tammy Flanagan Yeah, it’s not too early to start looking at some things because many of the 2026 brochures are out now. So you can go to your current plan’s website, look at the 2026 plan brochure, and on the cover, it’s going to tell you the page numbers in that brochure to find out what’s changing. In particular, you want to look at the premiums, but also look at your cost sharing, the deductibles, co-pays, co-insurance and even that catastrophic limit could be increased for next year. So just be sure you understand what you have and then start looking at the other alternatives.

Jared Serbu How common is it for people to actually make a change during Open Season? Do you have any idea what the rough proportion is between people who just kind of set it and forget it versus the people who look carefully every year and make some choices?

Tammy Flanagan Yeah, maybe you wouldn’t be surprised, but it’s about 95% of the federal workforce, including the retirees, don’t do anything to change their health benefit plan during Open Season. I think it’s like, if it’s not broke, it doesn’t need fixed. So therefore, they just stay with what they have, which is kind of unfortunate because even though that plan worked for you 20 or 30 years ago, you’ve changed. Your health plan has most likely changed in those 20 or 30 years. And there’s other plans out there that are comparable to what you have that might be less expensive, might offer different benefits that you need now. So I think everyone should take a look. There’s lots of plan comparison programs out there. There’s Open Season health fairs, even though we have a government shutdown. There’s a virtual health fair on benefits.gov that anybody can attend. So there’s a good place. And if you’re a NARFE member of the National Active and Retired Federal Employees Association, we’ve done a series of webinars and we’ll continue to do those throughout Open Season. So there’s lots of places to learn how to navigate the Open Season.

Jared Serbu So I’m going to assume our audience is representative of that 95% and probably have not made a lot of these choices in the past. So if you’ve never done this before, how hard is it to actually make these changes?

Tammy Flanagan I guess it can be confusing. It’s almost like paralysis from too much analysis because we have so many choices. If you look in any one region of the country, you’ll have anywhere from 20 to 25, even 30 or more, choices to choose from. And now we have the postal employees are in a subset of the federal health benefits program. So this is all kind of new to them. Even though those plans are very familiar, they’ve got different premiums. There’s a different way that they go to change those plans. So it’s not necessarily the easiest thing. It’s kind of like the things you don’t like to do, whether it’s filling out your tax return or any other dreaded activity, but it’s something that needs to get done and it can really pay off in the long run, so it’s worthwhile doing.

Jared Serbu And I’m going to ask you an it depends question here, but how closely do the price of the premiums in any given plan correlate to the kind of coverage that you’re going to get?

Tammy Flanagan You’re right, it depends. However, I will tell you that just because a plan has an extremely high premium, and a case in point would be the GEHA high option plan, for the family coverage, it’s going up next year over $300 a month. So that’s not small change when you multiply that by 12 months in the year. And that’s a good plan. It’s always been a great plan. However, because of the price increase, you might look at other plans that are comparable. Even the GEHA standard option or the high deductible option costs you much less, provide you very comparable benefits. So the price is sometimes more indicative of the cost it is to run that program. Like in other words, let’s say that plan has a very low copay on the GLP-1 for weight loss. So because of that, maybe a lot of people chose that plan because the copays on that prescription is low. I don’t know. But that could be the reason it’s driving the price more so than just the quality of the plan.

Jared Serbu And as you look at the brochures that we’ve seen so far for 2026, do they tell any kind of story? Are there trends that we see this year in terms of changes other than in general, prices are going up?

Tammy Flanagan Yeah, there’s some things that are being looked at. OPM always puts out a call letter every year to tell the health plan carriers what they want to see in those plans. They’ve taken out the gender operations, the surgeries for that, due to political atmosphere. They’ve increased the GLP-1 coverage, so every plan is supposed to now cover those weight loss medications. They want to make more information about opioid abuse and provide some tools for that. So yeah, there are some changes that are mostly positive. And like I said, look at that front cover. It’s going to tell you exactly where to find the changes in your plan, and then decide, do you like that kind of plan? Do you like a fee for service PPO plan where you can choose your own providers? Are you more comfortable with an HMO, where there’s a whole panel of providers that you can go to and they kind of monitor your health from a more inclusive way of doing things. So there’s all kinds of different plans to choose from. And the newest one that a lot of people are starting to realize is a good choice is a high deductible plan. And even though it has a high deductible, it has the option for either a health savings account or a health reimbursement arrangement, which can be a wonderful way to do your health insurance at a little less cost. And also a way to shelter some income from taxes if you qualify for the health savings account.

Jared Serbu And of course, one thing that is different this year for sure is there’s a pretty decent chance we’ll start this Open Season under a government shutdown. What do we know, if anything, about how that will affect the process this year?

Tammy Flanagan Yeah, I’m sure nobody thought that it would last through the beginning of Open Season, but now we’re starting to wonder. Open Season’s coming up real soon and the shutdown may not be over by then. So in that case, what I would do, because there’s really not good direction, OPM says, yes, you can still make changes during Open Season. Go to your agency’s electronic system. Well, if you don’t have access to that system during furlough, that could be difficult to do. So what I will suggest is go to the opm.gov website, download the standard form 2809, which is the health benefits election form. And I would mail that election into my HR office to that agency just in case. But wait a while, because I’m really hopeful, I got my fingers crossed double that this furlough will be over before the end of Open Season on December 8th.

Jared Serbu But we do have a sense that those paper forms are going to continue to be processed for folks who can’t get access to those electronic systems?

Tammy Flanagan They should be, and even if they’re not, at least you can show that you made the attempt to make that election before the end of Open Season. You may still have to go back and do it electronically, but, if you’re really concerned about changing plans or if you’re retiring before the end of the year, you need to submit that SF-2809 with your retirement application, because those changes may not take place until after you’ve separated. So, yeah.

Jared Serbu And given how long this shutdown has lasted already, people are going to be in different circumstances, possibly finding different kinds of employment to tide things over, which I guess may lead some people to think, I’m going to look at some other health insurance options and suspend FEHB. Can you do that? How hard is it? Do people do that?

Tammy Flanagan Yeah, the only people who can suspend rather than cancel their federal health insurance would be someone who retired and maintained that health insurance in retirement. But there’s only specific reasons that you can put it kind of on hold or in suspension. And that’s if you’re a military retiree or a family member who has TRICARE or military healthcare, or maybe you’re going to join the Peace Corps, get out of Dodge and go help someone in another country. You can suspend your health insurance, go under the PSCORE plan. If you’re on Medicaid, if you have low assets and income and you qualify for Medicaid benefits, you can suspend your federal plan because that’s going to be too expensive in some cases. And then also, if you’re going to use one of those Medicare Advantage plans that we’re seeing right now advertised so heavily in the marketplace, if you’re going to use one of the commercial plans, you can suspend, but that’s it. So otherwise it’s called cancelation. And if you carry that health insurance into retirement, I never recommend canceling. And I almost never say never, but in this case, I will use that strong of a word to say I would never cancel my federal health insurance. It’s such a valuable benefit.

Jared Serbu Glad you brought up Medicare because we haven’t really touched on that in any kind of detail yet. What considerations do folks who are on Medicare need to be thinking about that are different or additive to what we’ve talked about so far?

Tammy Flanagan Yeah, this is a tough call for federal retirees who are over 65 or approaching age 65, because this is the time you have to make a decision. You may have not made a health insurance decision in the past 40 years, but now you’re facing, what do I do? Do I enroll in Medicare? Will I keep my federal health insurance if I choose not to enroll in medicare? And the answer there is yes, unless you’re a postal retiree where they now require Medicare for most of the postal retirees. But for FEHB, you’ve never had to enroll. In fact, about 20% of our retirees do not take Medicare Part B when they turn 65 and they continue using their federal health insurance as they always did. But I would have to tell a lot of folks that if you choose Medicare A and B, which is referred to as original Medicare, you can find a federal health plan that’s going to kind of dovetail really nicely with that Medicare benefit, leaving you with virtually no out-of-pocket expenses for your healthcare other than a prescription co-pay. So it’s worth taking a look at these plans that offer a rebate, that waive your deductibles, co-pays, and co-insurance, and those that have really good prescription benefits if you’re using a lot of prescription medications.