FEHB Open Season plan comparison assists federal employees and retirees select their health coverage annually. If you’re trying to pick the right plan, learn how to compare apples to apples across different carriers and plans.
That means looking at premiums, deductibles, co-pays, and provider networks customized to your location and healthcare needs. Your open season decision thus guarantees you the appropriate coverage at an affordable price to meet your health needs throughout the forthcoming year.
Understand Open Season
The FEHB Open Season each year offers federal employees and annuitants a vital opportunity to evaluate and make changes to their health coverage. This time frame provides people the chance to choose the optimal health plan for their lifestyle–there is a possibility to add, switch, or terminate a health plan.
Many of you find open season overwhelming with all the plan options and changes to consider. It is critical to review plan information and compare all of your options carefully and make informed decisions! It’s an important time to re-evaluate your health insurance needs and make sure you’re getting the best coverage and protection for your money.
Use our plan comparison tools to get started — just enter your zip code or plan name.
The Basics
The FEHB Open Season starts on November 11, 2024, which gives you a window for making alterations to your health benefits. FEHB is the largest health insurance program for federal employees and their families.
This annual window allows you to sign up for a new plan, change from your existing coverage, or even cancel your FEHB enrollment altogether. For instance, FSA open season enrollments are conducted at this time and take effect January 1 of the following year.
Before the Open Season bell rings, you’d be smart to validate your current FEHB plan information and eligibility status so you can simplify your decision when the time comes.
Key Deadlines
Save the date – FEHB Open Season begins on November 11, 2024. It is important to note that the Transitional Postal Service Health Benefits (PSHB) Open Season runs at the same time as the Federal Benefits Open Season, aligning these critical periods.
You need to get all FEHB plan changes or new enrollments done before the closing date of Open Season. Don’t miss the chance to change your health benefits for next year – submit your enrollment decision on time!
Your Eligibility
Verify that you are a federal employee or annuitant for the FEHB Open Season. This is for authorized federal employees and annuitants. Postal employees and annuitants will be sent letters regarding their PSHB plan auto-enrollment outlining their individual choices.
Check your present employment/retirement status to find your particular FEHB or PSHB enrollment choices. You’ll want to find out whether you are eligible for family enrollments or particular plan types as a federal employee.
Open Season presents a critical opportunity to maximize health advantages.
FEHB Health Plan Comparison
Open Season for you and your family because the FEHB program is tricky. If you’re an eligible employee or annuitant, you can enroll in, change or cancel a current enrollment in a health plan. The FEHB health plan comparison tool helps by enabling users to search by zip code, plan name, or health insurance plan code, as well as employee type, pay frequency, and number of members being covered.
To compare apples to apples, you should look at premiums, deductibles, copays and out of pocket maximums. I know the comparison process can be complicated, but a careful review will yield an informed choice.
Feature Category | Description | Key Considerations |
|---|---|---|
Premiums | Bi-weekly or monthly cost for coverage. | Your share of the total premium. |
Deductibles | Amount paid before plan starts paying. | Higher deductibles often mean lower premiums. |
Copays | Fixed fee paid for specific services. | Varies by service (e.g., doctor visit, specialist). |
Coinsurance | Percentage of costs paid after deductible. | Often applies to services like hospital stays. |
Most you pay for covered services in a year. | Provides financial protection against high costs. | |
Formulary | List of covered prescription drugs. | Ensure your current medications are included. |
Network Access | Doctors, hospitals, specialists covered. | Verify your preferred providers are in-network. |
Referrals | Requirement to see a primary care doctor first. | Common in HMOs, less so in PPOs. |
1. Plan Structures
Understanding the differences between FEHB plan structures, including HMOs, PPOs, and HDHPs, is essential. Each plan type has a big impact on your provider selection and whether you may need referrals.
For example, HMOs usually require you to choose a PCP in their network and receive referrals for specialists, providing a more managed care experience. Conversely, PPOs are more flexible and let you see out-of-network providers (usually for a higher fee) and typically don’t need a referral to see a specialist.
HDHPs, usually combined with an HSA, have lower premiums yet higher deductibles that must be met before coverage begins, appealing to individuals who expect minimal medical expenses or prefer to save tax free for upcoming costs. Weighing these options and included standard and basic plans all depend on your expected usage and budget.
FEHB is not a one-size-fits-all program — through FEHB you can get PPOs, HMOs and even high deductible plans.
2. Network Access
Making sure that your choice doctors, specialists and hospitals are in the provider networks of potential FEHB plans is an essential step. You should compare geographic coverage and access to network providers for each health plan option.
For instance, if you reside in a rural location, a plan with an extensive regional network could be a better fit than an urban-centric plan. It’s helpful to know that there is a huge difference in cost for in-network vs. Out-of-network services between different FEHB plans.
Out-of-network care usually means more out-of-pocket costs, such as higher deductibles, copays or coinsurance. Checking online plan provider directories goes a long way in confirming continuity of care with your current providers.
3. Prescription Costs
Comparing the drug coverage and formularies across FEHB plans helps estimate your drug costs out-of-pocket. Formularies can differ greatly, so make sure your meds are covered.
You need to compare copays for retail and mail service pharmacy options to find savings. Mail order can frequently offer a 90-day supply at a lower copay than three 30-day retail fills.
Check for coverage of specialty drugs and high-cost prescription drugs, as these can be a big portion of total costs. Others will have lower drug costs if they have Medicare Part B primary.
If you have Medicare Part B primary, you may be eligible for a FEP Medicare Prescription Drug Program PREVENT that can help lower your prescription drug costs. Selecting a health plan with generous and affordable prescription drug coverage for your expected needs is crucial.
4. Out-of-Pocket Maximums
Out-of-pocket maximum = the most you’ll pay for covered healthcare expenses in a plan year. These are things like deductibles, copays and coinsurance.
By comparing these maximums across FEHB plans, you can safeguard against high-cost healthcare years. Choosing a plan with an out-of-pocket max that you’re comfortable with and within your risk tolerance is important.
A smaller out-of-pocket maximum affords you more protection in the event of an emergency or a surprise large medical bill.
5. Ancillary Benefits
FEHB plans offer more than core medical coverage. These may be wellness programs, health rewards, or discounts on health-related services. Certain FEHB plans might provide added perks, including rewards, discounts, or preventive care.
Consider FEDVIP options during Open Season, as these are separate enrollments but supplement your health plan! Look for plans which provide valuable add-ons such as telehealth, cessation programs, or gym memberships.
Consider the worth of these additional benefits in your final FEHB plan decision.
Careful comparison ensures optimal FEHB coverage. %%%
Beyond the Premium
Reviewing FEHB plans during open season means going beyond the monthly premium. There’s much more to the true cost of a plan, including out-of-pocket expenses and your future healthcare needs. A low premium sounds nice, but it just means you’ll pay more in deductibles, copays and coinsurance when you do get medical care.
Only by knowing your complete financial picture, including your expected health care costs, can you select a plan that delivers actual value, instead of simply a low sticker price.
Total Yearly Cost
To identify the best value FEHB plan, estimate your probable healthcare costs on the basis of prior consumption and expectations. This means summing up anticipated expenses such as physician visits, drug prescriptions and anticipated procedures.
For example, many plans have differing copays depending on the service — you could have a $20 copay for primary care visits but a $50 copay for specialists, or higher coinsurance for hospitalizations or lab work. A lot of times, they’re paying straight cash for prescriptions or specialist visits until the deductible or out-of-pocket maximum is reached.
Use tools such as OPM’s Health Care Comparison Tool and the Consumers’ Checkbook 2025 Guide to FEHB Health Plans — both of which give you personalized cost estimates based on your individual healthcare data and plan design. Retirees in particular need to leverage Checkbook’s Guide to calculate annual expenses with and without Medicare Parts A and B because coordination with Medicare is a huge factor in cost.
Long-Term Value
Assessing the long-term value of FEHB plans is crucial, especially as you approach retirement and Medicare eligibility. Understanding how Medicare coordination rules affect your FEHB coverage is vital.
For example, some plans offer premium reimbursements for Medicare Part B, which can significantly offset costs in retirement. Certain plans provide additional benefits or services that go beyond standard coverage, such as rewards programs.
Some members report earning money or points for completing health-related activities, like health assessments or daily habit goals. Individuals have mentioned earning up to $120 for completing three eligible daily habits or $50 for completing a health assessment.
Choosing a FEHB plan that offers robust coverage and benefits that will continue to meet your healthcare needs into retirement ensures continuity of care and financial stability. This decision directly impacts your overall financial planning and retirement income.
Provider Continuity
First, if you want to keep your existing doctors, see if they’re in potential FEHB plan networks. Be sure to verify that your preferred doctors, specialists and hospitals accept any new FEHB plan you’re thinking of.
Changing plans could mean switching doctors if your current providers are out-of-network with the new plan, causing potential interruptions in care or patient-provider relationships. Check the online provider directory for each possible FEHB plan so that you can have care without any bumps.
Some plans cover certain medical services at different rates – for example, preventive care, maternity care or mental health services – so verify that your specific needs are covered.
In short, look past the premium for real FEHB value. %%%.
Special USPS Guidance
The 2024 Open Season is bringing a big change for USPS employees and annuitants with the launch of the Postal Service Health Benefits (PSHB) Program. This new system means special USPS guidance to your health plan enrollment, as unlike traditional FEHB. Most important, is how these changes impact your options — such as whether you can be automatically enrolled to a PSHB plan based on your existing FEHB coverage.
You need to do whatever OPM details in their Open Season letter for all PSHB-ers.
PSHB Program
PSHB is a new health benefits program for postal workers, providing a convenient, confidential and secure method for USPS employees to enroll, make changes, or cancel enrollment for the first time. So, if you have an FEHB plan, you may automatically be enrolled in a PSHB plan.
For example, if you’re enrolled in the FEHB BCBS Basic Self Plus One Plan (113) you’ll be automatically enrolled into the new PSHB 33C BCBS SPO Plan. The new PSHB Plans will go into effect January 1, 2025. While this auto-enrollment seeks to guarantee uninterrupted coverage, it is essential to examine your PSHB auto-enrollment information and decide whether you need to make any adjustments during the Transitional PSHB Open Season, which runs until Monday, December 9.
Unique Options
USPS employees and annuitants have unique plan options this Open Season, including the new PSHB plan options. These plans may feature different benefits or cost structures compared to traditional FEHB plans, such as the PSHB Part D Employer Group Waiver Plan (EGWP). In a PSHB Part D EGWP, members can enjoy benefits like a $35/month insulin cap and a $2,000 annual cap on Part D drug out-of-pocket costs, making it a valuable choice for federal employees seeking health insurance plans that suit their needs.
If you are already enrolled or considering enrolling in an FEHB MAPD EGWP, it’s crucial to reach out directly to the PSHB plan with questions, as there are significant distinctions in these programs. Evaluate whether the new PSHB plans align better with your healthcare needs and budget as a USPS employee, especially during the month enrollment period.
Remember, you can change your enrollment outside of Open Season if you experience common occurrences known as Qualifying Life Events (QLEs). This flexibility is essential for federal employees working past age retirement, ensuring they have access to the best health coverage options available.
Available Resources
For PSHB participation and enrollment details, see OPM’s Open Season letter. Here’s an important letter about your choices. Active employees can obtain hard copies of plan brochures from their benefits coordinator or download them from the OPM website.
Annuitants should register for FEHB Open Season Online or PSHB Open Season Online to request or download brochures. Check the government websites and resources for the latest information on the PSHB program.
Additional information on automatic enrollment can be located in the Automatic Enrollment in PSHB section of my site. TCC participants have to cover 100 percent of the premium for their plan choice — employee and government portions — along with a 2 percent administrative fee.
In short, check PSHB changes to lock in health coverage.
Avoid Common Mistakes
Federal Employees Health Benefits (FEHB) Open Season is upon us, so let’s discuss how to ensure your health insurance plan is suitable for your needs. Failing to compare health plan options can lead to higher costs or inadequate coverage, leaving you without necessary benefits until the next FEHB Open Season. Taking sufficient time to evaluate all your FEHB plan choices is crucial.
The Autopilot Trap
Don’t just blindly re-enroll in your current FEHB plan. Your needs, provider networks and plan benefits can change every year. For example, a hospital or specialist you trusted last year might not be in-network with your new plan, or a prescription drug you now need could have shifted formulary tiers.
Changes to provider networks and prescription drug formularies are de rigueur for annual health plan updates, so take note of these adjustments. Make a commitment to review your FEHB plan every Open Season even if you’re happy with your coverage. Neglecting to re-evaluate can mean missing out on superior coverage or major savings that an alternative plan might provide.
Brochure Neglect
Read the actual individual FEHB brochure for any plan you are considering, to find out what it really entails. These brochures are the authoritative benefits and limitation statements for each FEHB plan. Plan brochures are available online from OPM or you may order hard copies through your agency benefits coordinator or FEHB Open Season Online.
It is important to consider plan information – such as the brochures and supplementary materials — to determine which plan fits your needs best. Be sure to pay close attention to important sections in the brochure, including covered services, any exclusions, and cost-sharing details (e.g., deductibles, copayments and coinsurance percentages).
Premium Fixation
Don’t be tempted to select a FEHB plan just because it has the lowest monthly premium! A cheap premium is usually accompanied by high deductibles and/or high copays and coinsurance percentages, resulting in higher total out-of-pocket costs during the year.
In comparing health plans, it’s not enough to look at the monthly premium; you need to consider the total cost you could face, including deductibles, copays, and coinsurance. Don’t select a plan based solely on premium costs, because deductibles, copays and coinsurance can really add up.
For instance, a HDHP may be costly because of its deductible, but it can be a good fit for someone with low projected medical bills when combined with an HSA. Understand the tradeoffs between premium and coverage to determine the right health insurance plan for your budget and needs.
Keep in mind that certain plans can have varying rates for Self Plus One and Self & Family coverage, so it’s important to know this when making your choice. Knowing in advance how a health plan would coordinate with other insurance coverage such as Medicare is important when making coverage decisions and can help prevent gaps in coverage.
Common mistakes to avoid for best FEHB plan choice.
The Self-Advocacy Mindset
The self-advocacy mindset means taking ownership of your federal employee health benefit program selection. This mindset involves being at the helm of your own life, charting out your course, and being aggressive in pursuing well-being. Here’s why users of this approach are more confident, assertive, and successful in advocating for their healthcare needs.
It’s a critical life skill for the FEHB program and beyond, ensuring your dignity remains intact during open season.
To maximize this mindset, actively utilize the plan comparison tools and guides available through the Office of Personnel Management (OPM). Tools such as the Health Care Comparison Tool and Consumers’ Checkbook provide objective information to evaluate various health insurance plans. These resources enable you to compare premiums, deductibles, out-of-pocket maximums, and specific coverage details among different FEHB options.
Actively looking for this information is the heart of self-advocacy.
Additionally, it’s important to ask detailed questions about plan benefits, provider networks, and prescription drug coverage to get a clear understanding. For example, see whether your current doctors are in a plan’s network or if a particular medicine is covered at a preferred tier.
While some of us are hesitant to self-advocate because we don’t like confrontation or are afraid of sounding pushy, keep in mind that making sure these details are clear is related directly to your care. A self-advocacy mindset means you’re not afraid to ask for assistance when it’s warranted and refuse to accept vagueness.
Empower yourself to make a decision that best supports your health and financial well-being. This active involvement may result in increased independence and confidence in navigating your medical care.
Cultivating this mindset takes practice and self-reflection, and it strongly correlates with improved mental health outcomes, such as higher self-esteem and satisfaction with your decisions. FEHB open season is your opportunity to take control of your future healthcare experience.
Bottom line: self-advocacy is paramount to smart FEHB plan selection.
Conclusion
Open Season provides you a crucial opportunity to choose your health plan. To select wisely, consider more than just the monthly bill. Think about your family’s health needs and regular visits to the doctor. Review plan benefits, deductibles and out-of-pocket limits carefully. There are special rules for USPS employees — know them well. Don’t just roll your old plan. Own your health care. Select a plan that really suits you and your family. Begin reviewing your options today. Make a bold choice for next year.
Frequently Asked Questions
What is FEHB Open Season?
FEHB Open Season is the annual window during which federal employees may sign up for, modify, or terminate their health insurance plans. It’s your once-a-year chance to ensure your federal employees health benefits fit for the year ahead.
How can I compare different FEHB health plans?
Utilize the official plan comparison tool on the U.S. OPM website to compare health insurance plans side-by-side, including premiums, benefits, and provider networks for all federal employees health benefits in your area.
What should I look at besides the monthly premium?
Review the plan’s deductible, copayments, out-of-pocket maximum, and prescription drug coverage as part of your federal employees health benefits. Verify that your favored physicians and hospitals are in the health insurance plans network to control your overall health care expenditures.
What happens if I do nothing during Open Season?
Your existing federal employee health benefit program will automatically renew into next year. Since premiums, benefits, and provider networks can change, it is always best to actively review your health insurance plan options to confirm it is still the right choice.
Are there different rules for U.S. Postal Service employees?
Yes. The majority of USPS employees, federal annuitants, and their families are covered under the federal employee health benefit program (FEHBP). You need to choose a PSHB plan during the FEHB open season to maintain your health coverage.
Can I change my plan outside of Open Season?
Generally, federal employees are unable to switch health insurance plans outside of Open Season unless they experience a Qualifying Life Event (QLE), such as marriage, having a baby, or relocation.