Every November, the Federal Employees Health Benefits Program opens for annual enrollment. Every year, the majority of federal employees do nothing and let their current plan auto-renew. That is often a mistake that costs hundreds or thousands of dollars.
FEHB premiums change annually. Coverage terms shift. Your health needs evolve. A plan that made sense three years ago may not be your best option today.
The Open Season Window
FEHB Open Season typically runs for 47 days each November and December. Changes take effect the first full pay period of January. Outside of Open Season, you can only change your FEHB enrollment due to a qualifying life event such as marriage, divorce, birth of a child, or loss of other coverage.
5 Things to Actually Compare
1. Total Premium Cost
The government pays approximately 70-75% of your FEHB premium. Your share of the premium is deducted pre-tax from your paycheck. Compare your biweekly share across similar plans, but do not stop there. The premium is only one piece of your total annual health care cost.
2. Deductible and Out-of-Pocket Maximum
A plan with a lower premium but a $3,000 deductible may cost you more than a plan with a slightly higher premium and a $500 deductible, depending on how you use health care. Look at the out-of-pocket maximum, the most you would pay in a worst-case year, to understand your true financial exposure.
3. Your Doctors and Specialists
If you have established relationships with specific physicians, verify they are in-network before switching plans. Out-of-network costs can be significantly higher under some FEHB plans, and some plans do not cover out-of-network care at all except in emergencies.
4. Prescription Drug Coverage
Review the formulary for any maintenance medications you take regularly. The difference in cost-sharing between a Tier 1 and Tier 3 prescription can be $50 to $100 or more per month. If you take multiple medications, this comparison alone can determine which plan saves you the most money.
5. FEHB in Retirement
If you are within five years of retirement, pay close attention to one rule: to carry FEHB coverage into retirement, you must have been continuously enrolled in an FEHB plan for the five consecutive years immediately before your retirement date.
If you are enrolled and planning to retire, staying enrolled is not optional, it is essential. Losing FEHB coverage in retirement means paying full private market premiums for health insurance for the rest of your life.
Where to Compare FEHB Plans
The Office of Personnel Management maintains a plan comparison tool at opm.gov. You can compare premiums, benefits, and cost-sharing side by side for every plan available in your geographic area.
Do not rely on your agency’s benefits fair or a coworker’s recommendation alone. Spend 15 minutes on the OPM comparison tool before the Open Season window closes.
Bottom Line
Auto-renewing your FEHB plan without comparison is the benefits equivalent of paying full price for something that might be on sale next door. The government is paying the majority of your premium either way. Make sure the plan you are paying your share toward is actually the best option for your health needs and budget.
Educational content only. Not personal financial, medical, or benefits advice. Consult your agency benefits officer or OPM for guidance specific to your plan options and situation.
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