By comparison, the average premium increase across all FEHB plans for 2026 is 12.3%, when taking into account the 47 carriers offering a total of 132 total plan options for next year. Not all plan options are available to all FEHB enrollees, as some are specific to certain agencies or geographic regions.

Premium costs, however, are far from the only factor that enrollees should be considering when making a plan selection, according to federal health plan experts.

“FEHB enrollees losing their NALC health plan should carefully consider which health plan will be the best fit for them,” said Kevin Moss, director of marketing and fundraising at Consumers’ Checkbook. “Besides reviewing the plan premium and out-of-pocket costs for benefits, make sure to check the website of the new plan you’re considering to see if your current providers will be in-network, and how any prescription drugs you may take will be covered.”

Notably, the lowest-cost nationwide plan, GEHA Elevate, has lower premiums, but also much lower coverage than GEHA High. NALC High — which the vast majority of those impacted by OPM’s decision are coming from — is more similar to GEHA High than it is to GEHA Elevate, but still with some differences in benefits.

For instance, an enrollee in NALC High who had a $300 deductible for a “self only” plan in 2025 would move to a $500 deductible in 2026 under GEHA High. By comparison, the enrollee’s deductible would increase to $750 under GEHA Elevate.

As another example, an enrollee in NALC High with a catastrophic out-of-pocket maximum of $3,500 for a “self only” plan would see that limit increase to $7,500 under GEHA High. The out-of-pocket maximum for GEHA Elevate, in contrast, is $10,600.

John Hatton, senior vice president of policy and programs at the National Active and Retired Federal Employees Association (NARFE), said a higher-premium plan with more coverage may be the best plan for some enrollees, but not necessarily others.

“Maybe the high premium plan with more coverage is the right choice for you, but you may want to look at some other alternative plans that might be cheaper. Because there are options, even with really low deductible plans, that have lower premiums than the main big dogs in the program,” Hatton said in a recent interview on The Federal Drive. “So it’s really critical that you look and choose what’s best for you.”

The post Over 30,000 feds facing possible FEHB premium spike next year first appeared on Federal News Network.

Interview transcript:

Terry Gerton: Open Season kicks off today. People might have been a little distracted by all the other things that are happening in the federal government and with the federal workforce, but if they wake up this morning and they’re listening to us, they go, ‘Oh my goodness, it’s Open Season.’ What should they know initially about timelines and important things to look at?

John Hatton: Well, they have from today until December 8th to make a choice of plans. And we highly encourage people to look at their plan options every single year. But really, this year, it’s even more critical with the second year of double-digit premium increases. So you really have an opportunity to save money by choosing a different plan in many cases. There’s a lot of good plan options with quality comprehensive coverage. And so it’s really just about making sure you’re able to walk through a process that makes you feel confident in that change of plans and choice. And so we’re there to always help people with that decision-making process, but really encourage people to go through it.

Terry Gerton: If people are furloughed and they’re not seeing their office emails, they don’t have access to their work computer, does that pose a challenge for anybody getting ready to enroll?

John Hatton: People should still be able to enroll through the normal portals. I think where it poses a challenge with the shutdown ongoing is just communication from federal agencies. So OPM is still up and running. They have funds paid essentially through your premiums for administration of the program. But the agencies are shut down and you may not have health fairs going on. You may not have communication through agencies. You may be lost in terms of where to go to enroll and sign in. And so that part I think will be challenging for people, but accessing, being able to actually make a change and accessing OPM, hopefully should not.

Terry Gerton: So they’re going to have to do a little bit more of their own research at that point. Talk to us or point us in the right direction about what’s new and what people should really be paying attention to in this year.

John Hatton: Well, plan options remain pretty broad and comprehensive and there are tweaks from year to year. I think on the program-wide basis, there are some additional required coverages like PrEP medications for HIV treatment. The administration took away gender-affirming care treatments. There continues to be IVF coverage for infertility treatment in the program. So each plan has to cover at least one GLP-1 medication. So there are some tweaks around, I would say, the edges of the program in terms of program-wide, but I think people really need to take a look at their individual plan. And each plan may change, and I think we’ve seen a little bit more changes, plan-to-plan, than we typically see or that we’ve see in the past. I know on the postal side, there’s some tweaks to Medicare reimbursements, which a lot of retirees find critical. So if you already have Medicare, you can get some money off those premiums in certain plans. There’s been some tweaks on the Pulsar side, but not the federal side for that. So I think it’s really important for people to look at that section two of the plan brochure and take a look at the individual changes because not only are you facing these increases in premiums, you may have changes in your underlying plan.

Terry Gerton: So let’s talk about those premium changes. This is a second year of double-digit premium hikes. What’s driving the cost increases?

John Hatton: I wish I could give you a very specific answer. OPM provided some very generic answers like costs of providers have gone up, some increased utilization of prescription drugs, including GLP-1s, is probably the most specific thing they provided. But the costs of health care are going up across the country and that’s reflected in these premiums.

Terry Gerton: Health care premium costs are a big issue in the shutdown conversation and negotiation. Is that related to the prices folks are seeing for the federal programs?

John Hatton: Mostly no. The issue over the ACA premiums is whether to extend enhanced subsidies. So this is on the Affordable Care Act exchanges for people who don’t have employer-based coverage, don’t have Medicare, don’t have Medicaid. And during COVID, one of the bills that passed enhanced those subsidies. So it used to be up to a certain amount. There are now stronger subsidies. So if those go away, people are seeing potentially triple-digit increases in their premiums in terms of percentage from just large amounts of money that are going to really make it hard for people to retain their health care coverage at all. And they don’t have, I don’t think, the same ability to choose a new plan that saves them more money the same way you may in response to the FEHB premium increases. There is still underlying increases in those premiums, though. So I think maybe 26% on the Affordable Care Act is changed if you take away the subsidies. So that is related. There’s an underlying premium increase that’s across the board that’s affecting both FEHB and the Affordable Care Act, but the issue with the shutdown is these enhanced subsidies that allow people that don’t have employer-sponsored coverage to get affordable health care. And that’s kind of been the crux of the Affordable Care Act in the first place is providing some safety net and alternative outside of your employer-based coverage and luckily, federal employees and retirees have that employer-based coverage in its quality. But some people in this country don’t.

Terry Gerton: I’m speaking with John Hatton. He’s staff vice president of the National Association of Active and Retired Federal Employees. John, let’s come back to the OPM plans. They made some changes to default plans for folks whose coverage is going away. What do people need to know if they’re looking at an automatic enrollment? How is that process going to play out and what if it doesn’t fit their needs?

John Hatton: Yeah, anytime your plan is dropping out, you’re defaulted into a different plan. So you don’t totally lose coverage. You don’t have to make an affirmative choice. That’s a good positive thing. This year, the NALC plan is dropping out of the federal side of the program. They’re still on the postal side. So if you’re a postal employee or retiree, you can still retain it. But that’s a significant number of people. OPM made the choice to not default into the lowest cost nationwide plan without a high deductible and without an association membership fee. That’s what the regulation says. Then it has another sentence that says they reserved the right to designate an alternate plan for automatic enrollments. So this year, the lowest cost nationwide plan would be the GEHA Elevate plan, but instead, they have designated the GEHA High plan. So in the past, you would be automatically enrolled into a low-premium plan. In this case, you’re automatically enrolled into a high-premium plan. So particularly if you had a consumer option in NALC, for example, you’re going to see a huge spike in increases if you just defaulted in and you don’t make an alternative choice. So we really encourage people to choose. I mean, maybe the high premium plan with more coverage is the right choice for you, but you may want to look at some other alternative plan, even with those low deductibles that might be cheaper because there are options, even with really low deductible plans that have lower premiums and kind of the main big dogs in the program. So really critical that you look and choose what’s best for you.

Terry Gerton: So back to our point at the beginning, which is people really need to do some research, especially if they don’t have access to the experts in their organization.

John Hatton: Yeah, and NARFE provides resources. We have webinars that walk people through their options and really step-by-step, how do you simplify the process? We actually surveyed members and first of all, about less than 5% of people change plans every year, unfortunately. And I think that’s because they also said about 80% or more are content with their plan. But people are not content with these huge double-digit premium increases. But the reason they often, I think, don’t change is because the complexity of the process and they’ve said they’d rather write at-will or read Shakespeare in terms of understanding the process. So we really try to simplify it step by step so you can feel confident that if you’re making a choice that lowers your premiums, you’re still retaining some quality coverage. And I think that’s what people are most worried about. They have a plan that works for them. They don’t like the premiums are going up, but for them to switch, they’re taking a risk and a leap of faith that this other plan is going to do and meet their needs the same way. And I think when people realize that they could be leaving potentially thousands of dollars on the table, like that’s the difference in premiums. It’s for self-only plan for similar low deductible plans. It’s $200 a month. For self and family, it’s $500 a month. If you’re switching to a high deductible plan, it’s even more. So you could have $7,500 in premium difference in some cases from one plan to another. And yes, you’re risking a higher deductible, but it’s maybe $1500 more or something like that. So you’re going to save $6,000 just on premiums and have to maybe pay a little more out of pocket after the fact. So just thinking about some of those things and what the trade-offs really are with some of these choices, it’s a lot to navigate. It’s complicated. People don’t understand the terms all the time. They don’t understand the tradeoffs and they want to make sure they can get health care when they need it. The plan is designed to utilize the fact that you have a choice in plans. It’s a great competition to help drive down costs. And when people aren’t actually making a choice, it’s not really working that way. So I think we’ve seen these double-digit increases in part because people aren’t making those choices.

The post Open Season starts Monday and feds face rising premiums and tough choices on coverage first appeared on Federal News Network.