OPM health insurance changes highlights include enhanced telehealth access, higher maximum out-of-pocket thresholds, and premium and deductible tweaks.
The New Two-Program System
The federal health insurance environment has been divided into two distinct programs: the Federal Employees Health Benefits (FEHB) program and the Postal Service Health Benefits (PSHB) program. This division enables OPM to service more particularly the unique healthcare needs of federal employees and postal workers. Both programs have different plan options, carriers, and administration to better suit their members. This split significantly impacts when plans are offered, how employees sign up for health insurance coverage, and what options they have, particularly with the pending plan availability and premium changes.
FEHB Explained
The FEHB program offers health insurance coverage to most federal employees, retirees, and their families. It spans a diverse set of plans: HMOs, PPOs, Fee-for-Service, Consumer-Driven Plans, and High-Deductible Plans. FEHB has 132 plans from 47 carriers for 2026, with six plans dropping and affecting approximately 32,000 members.
FEHB plans differ in the proportion of premiums and costs paid by the government and employees. Here are key types of FEHB plan contributions and their effects on employee expenses:
- Government-Paid Portion: Typically covers about 72 percent of the weighted average premium.
- Employee Share: In 2026, federal employees and retirees will see an average premium increase of 12.3%.
- Enrollment Types: Include Self Only, Self Plus One, and Self and Family, each with different premium rates.
- Cost Sharing: Deductibles, copayments, and coinsurance vary by plan type and affect out-of-pocket expenses.
You must be a federal employee to qualify for FEHB, and you can enroll either during open season or within 60 days of a qualifying life event. New employees have 60 days from their start date to sign up. If you miss this window, your coverage could be delayed. With these premium increases and plan changes, federal employees should shop around during open season to find plans that fit their needs and budgets.
PSHB Explained
As the PSHB program is just for postal workers and retirees, it is separate from FEHB, with 75 plan options from 17 insurance carriers. These are a combination of national and regional HMOs and FFs for postal workers’ specific geography and work circumstances.
PSHB premiums typically increase less than FEHB, with total premiums increasing 9.0% and employee and retiree shares increasing 11.3% on average. Benefit structures in PSHB plans tend to vary a bit from FEHB, as they cater to the particular needs and demographics of postals. Geography is a bigger factor for PSHB plans. Some plans are available only in certain locations, so postal workers’ options vary based on their duty station.
Postal employees have to enroll within 60 days of their entry into the program or the open season. If participants fail to actively select a plan, OPM may automatically enroll them in a plan with benefits and cost-sharing similar to their previous coverage so they don’t have a lapse in coverage.
Why the Split?
Dividing the FEHB and PSHB allows OPM to tailor federal employees health benefits and administration to the distinct populations they serve. Postal workers may have unique healthcare and geographic considerations compared to the general federal workforce. This separation enables OPM to focus on operational efficiency, plan design tailoring, and effective cost control.
This divide helps plan members. It allows for more focused plan offerings and greater control over premium hikes, which have been rampant in recent years. For example, the FEHB program’s average premium increase of 12.3 percent compared to the PSHB’s 9.0 percent illustrates how the programs individually adjust to market and demographic pressures.
This distinction elevates the attendee experience. It streamlines health benefits enrollment, clarifies eligibility guidelines, and empowers each program to negotiate for plan options that prioritize their members. Moreover, it broadens selection in ancillary coverage, like dental and vision insurance programs, where both programs feature multiple carriers, albeit fewer than a dozen each.
What Are the 2026 OPM Health Insurance Changes?
OPM 2026 FEHB and PSHB Health Plan Changes — What Are the 2026 OPM Health Insurance Changes? Premium increases, redesigned benefits, updated prescription drug policies, new plan options, and details about the implementation for postal employees will come into effect in January 2026, affecting over 30,000 federal enrollees and forcing many to rethink their plans during Open Season.
Category | FEHB 2026 | PSHB 2026 |
|---|---|---|
Average Premium Increase | 12.3% |
|
11.3% |
|
|
|Govt. Contribution|$324.76 (Self Only)|Similar structure as FEHB
| | $711.17 (Self Plus One) | |
| | $778.03 (Self and Family) | |
| PLAN OPTIONS | 132 (47 carriers) | 75 (17 carriers) | | Plan Types | Mix of national/regional HMOs, FFS | Similar mix with regional variations | | NEW BENEFITS | Extended hospice care, anti-obesity coverage | In tune with FEHB benefit changes | | Prescription Formularies | Enhanced with new, FDA-approved anti-obesity drugs | Identical updates to FEHB |
1. Premium Adjustments
FEHB enrollees will experience an average premium increase of 12.3% in 2026, with Postal Service Health Benefits members facing a slightly lower rise of 11.3%. These increases reflect ongoing trends of rising healthcare costs and the aging population of enrollees, whose average age is about 47 for active federal employees and 60 for retirees. The government’s maximum biweekly contribution for federal employee health benefits will be capped at $324.76 for Self Only, $711.17 for Self Plus One, and $778.03 for Self and Family. These limits help determine how much the government contributes to premiums for different FEHB enrollment types.
The premium hikes stem from various pressures, including increasing prescription drug prices and medical service costs. Federal employees and retirees should pay close attention to their health insurance marketplace options during Open Season to avoid unexpected premium spikes. Additionally, enrollees may face significant rate increases if they remain in plans that are being discontinued or are not adjusting their coverage adequately.
2. Benefit Redesigns
Several key updates to FEHB and PSHB benefits will affect coverage in 2026. Preventive care benefits continue to evolve, including expanded coverage for anti-obesity treatments such as FDA-approved GLP-1 medications. Hospice care coverage now extends without requiring prior approval, making it easier for enrollees to access these services when needed. Coverage for medical or surgical modifications of sex traits has been removed from the plans.
FEDVIP dental and vision benefits have been improved. For instance, dental plans now include two routine and one emergency exam annually, along with additional preventive care for young children and pregnancy wellness. Vision plans have extended coverage of diabetic eye care and orthoptic training for eye movement disorders, demonstrating a continued dedication to holistic health care.
3. Prescription Formularies
Prescription drug coverage plans will have new formularies for 2026. This encompasses coverage of newer FDA-approved anti-obesity medications, with plans needing to cover a minimum of one GLP-1 drug and other oral alternatives. To support cost efficiency, an annual pharmacy out-of-pocket maximum of $2,100 per member has been established across plans.
Mail Service Pharmacy copays will be $140 for preferred brand-name drugs and $175 for non-preferred. These cost-sharing measures are intended to strike a balance between access to necessary medications whereas attempting to control prescription costs. OPM is working with carriers to control waste and encourage the use of cost-effective medications[4][5].
4. New Plan Options
In 2026, FEHB presents 132 plans from 47 carriers, and PSHB offers 75 plans from 17 carriers. Both programs offer a combination of national fee-for-service plans along with local HMOs based on service area. Six FEHB plans will be dropped, impacting some 32,000 enrollees, as new carriers and plans are coming on board.
Federal employees and postal workers should turn to OPM’s online plan comparison tools to investigate these possibilities, paying attention to coverage levels, premiums, and network access. It’s a must-have for selecting plans that align with your needs and budget.
5. PSHB Implementation
A bit of postal-specific news, too: The Postal Service Health Benefits program changes will roll out alongside FEHB adjustments, featuring some postal-specific details. Postal employees are able to choose from new plan choices and coverage tiers available in their local areas. PSHB’s premium rate changes for its enrollees mirror the overall program increase but differ somewhat depending on location and eligibility status.
Postal workers have their own enrollment and plan selection rules owing to their situation as employees, but the 2026 changes are meant to bring PSHB in line with FEHB on coverage and cost-sharing. It facilitates administration and guarantees postal workers similar enhancements in their health coverage[1][4][6].
How These Changes Affect You
About how these changes affect you, federal employees, retirees, and postal workers will experience actual changes in health insurance coverage and costs for 2026. Premiums are up across the board, with the typical enrollee share rising 12.3%, marking the second consecutive year of double-digit increases. More than 30,000 enrollees may face sharp increases if they don’t shop during the federal benefits open season. Some could see more than a 200% jump in premiums if they take auto-enrollment into a new plan option. These shifts in plan availability and design imply that doing nothing may leave you with a health plan that no longer aligns with your needs, particularly if you’ve experienced major life milestones such as marriage or a new baby.
Your OOP Costs
Anticipate increased deductibles, coinsurance, and out-of-pocket maximums for 2026 within the federal employees health benefits program. For instance, certain plans now include out-of-pocket maximums of up to $10,600. These hits families harder, as family plans tend to receive bigger jumps in premiums and cost-sharing on both. Single plans can increase in price, but the effect is typically less severe. Checking on your health insurance coverage is crucial to sidestep surprise charges, particularly if you or an eligible family member require continuing care. Think about increasing your federal flexible spending account coverage to mitigate these increased out-of-pocket costs. If you’re an enrollee with a chronic condition or require frequent care, you should be on high alert.
Retiree Coverage
Retirees in the federal employees health benefits program will pay the same premium increases as active employees. The government’s portion continues to be 72% of the weighted average, but premium increases are making retirees pay more. Some benefit options may be scaled back or reorganized, and it’s worth seeing if your existing health insurance coverage still provides the coverage you require. Those retiring to Medicare should check how their FEHB plan interacts with Medicare, as changes may impact coverage gaps or supplemental benefits. Government contribution changes are modest, so retirees can anticipate increased net premiums unless they move to a plan with lower costs.
Postal Worker Impact
Postal workers under the PSHB program will experience a marginally smaller premium increase of 11.3%, but they will endure higher costs and fewer plan options compared to the federal employees health benefits program. Coverage options depend on where you live, and in some regions, there are only a few plans available. Since these options differ from FEHB, postal workers should carefully check their health insurance coverage. Additionally, some workers may have limited access to preferred providers or specialized care.
- PSHB plans may offer fewer nationwide options than FEHB.
- Some regions have only a few plan choices.
- Coverage for certain services may be more limited.
- Auto-enrollment may not match previous benefits.
- Geographic restrictions can affect access to care.
Navigating Your OPM Change Health Insurance
Managing health insurance changes during the federal employees health benefits Open Season or after qualifying life events requires careful attention to deadlines, documentation, and plan details. Open Season is the time when you are allowed to enroll, change plans, cancel coverage, or adjust premium conversion if you are eligible. Your old carrier covers through January 24, 2026. Open Season changes become effective January 25, 2026. Outside Open Season, changes are permitted for life events such as moving, getting married, getting divorced, or losing other coverage. Although most federal employees and retirees—around 95%—do not change plans each year, it is still important to review your options, especially with health insurance coverage premium increases and new plan features.
Family Status
Certain changes in status, such as getting married, divorced, or adding dependents, can directly impact your federal employee health benefits and PSHB coverage. It is essential to report these changes within 60 days to maintain your coverage. For instance, enrolling a spouse or child necessitates a marriage certificate or birth certificate. Additionally, removing a family member after divorce or death requires proof. Changes in your family status can affect premiums and plans, with transitioning from Self Only to Self and Family potentially raising your premium but being appropriate if you’ve recently married or have children. Always consult the 2026 FEHB plan brochures for updated coverage and cost information.
Employment Status
Here’s what new hires, retirees, and employees changing agencies can do to enroll in the federal employees health benefits program. Changes get a special enrollment period to enroll in FEHB or PSHB. While retirees can stay on coverage or transition to Medicare, around 20% don’t take Medicare Part B and retain their federal health insurance coverage. If you’ve relocated to a new agency, it’s essential to update your plan if you’re now outside your plan’s service area. Remember that part-time or intermittent employment can impact eligibility — check with your agency! When your job situation shifts, ensure your coverage is switched to prevent any gaps.
Other Coverage Loss
Losing other health coverage, such as Medicaid or a health insurance marketplace plan, qualifies as a qualifying life event. This allows you to enroll or change plans outside of Open Season, ensuring you have access to federal employees health benefits. You’ll need proof, like a termination letter from your previous insurer, and must enroll within 60 days of losing coverage. For example, if your spouse’s employer plan terminates, you can switch to a FEHB plan or PSHB, keeping you covered and out of trouble.
An Insider’s Perspective on the Shake-Up
Neither of us anticipated the 2026 changes to OPM’s health insurance programs would be such a big deal for federal employees. More than the headline premium hikes, these changes are indicative of the underlying struggles and transitions in the management of federal employees health benefits in the federal workforce. To truly understand these changes, we need to step back and examine the wider effect on employees’ finances, how health insurance coverage has trended for years, and where the corporate messaging leaves off.
The Real Cost
Healthcare spending for federal employees isn’t limited to premiums. Here’s a simplified breakdown of typical annual healthcare costs:
Cost Component | Approximate Annual Cost (USD) |
|---|---|
Premiums | $2,400 – $2,800 |
Deductibles | $1,000 – $1,500 |
Copayments & Coinsurance | $500 – $800 |
Out-of-Pocket Maximums | $3,000 – $4,000 |
Premiums have soared, rising 12.3% in 2026 after increasing 13.5% the year before. This, by itself, stretches take-home pay, particularly for lower-wage federal employees who could be hit harder due to percent-based premiums because they take up a bigger portion of their income. The financial story is more complicated. Deductibles and copays contribute significant out-of-pocket expenses, which can interfere with budgeting and savings.
Too many enrollees concentrate solely on premium costs. Neglecting to regard their total expenses can result in unwelcome surprises. Consider the federal worker with a chronic condition who’s now confronted with higher deductibles and frequent copays. The cost of coverage is much steeper than premiums would suggest. This subtlety is key for workers weighing their choices during Open Season.
Long-Term Outlook
Going forward, the federal employees health benefits program and PSHB will continue to experience premium increases and changing benefits. OPM is driving cost control that involves fraud detection, waste reduction, and encouraging wellness instead of reactive care. The existing system, as is often said, is “broken,” and it relies too much on prescriptions instead of wellness and prevention.
OPM is seeking to transition from a “sick care” to a “well care model” as part of this shift, advocating for healthier lifestyles through improved nutrition and exercise while re-evaluating coverage for select drugs like GLP-1s. This speaks to a more general objective of trying to make healthcare spending more sustainable within the framework of the affordable care act.
Technology is helping, too. AI tools could soon assist federal employees to make smarter health insurance decisions by analyzing personalized data, potentially saving seven to eight percent a year if employed effectively. Still, the health insurance marketplace is seeing plan options shrink and contributions from the government are strained, so employees must take a more active role in plan selection to balance cost and benefit.
What OPM Isn’t Saying
Whereas OPM’s public messages emphasize premium rates and plan availability, important specifics regarding the federal employees health benefits program remain vague. They’re not disclosing potential benefit cuts or network restrictions that could impact care quality for federal employees. Some plans are dropping, and service areas are moving around, which may restrict choices based on where a federal employee resides.
Premium hikes’ sustainability remains a worry, and enrollees continue to be frustrated with premium increases without explanations on controlling them. Eliminating fraud and waste is a nice goal, but the government has not been specific about how it intends to do that within the health insurance marketplace.
Federal workers need to be aware of these gaps and inquire about plan specifics, particularly on coverage changes and network restrictions. It is crucial to challenge assumptions and seek clarifications at Open Season to limit surprises after health insurance coverage kicks in.
Making Your Open Season Decision
The 2026 Open Season extends from November 10 to December 8, 2025, providing you a dedicated timeframe to evaluate and modify your federal employees health benefits. This yearly window is crucial since your existing health insurance coverage won’t necessarily roll over to the next year under the same conditions. Plans change. Premiums move. Coverage options vanish. Without active review, you risk overpaying for under-protection or missing out on opportunities that better align with your real-world healthcare usage.
Review All Plan Options Carefully
Begin knowing what you have to work with. There are 132 plan options available through 47 carriers for the 2026 FEHB Program, but six FEHB plans are being eliminated, so some enrollees have to choose new coverage. If you’re in one of these discontinued plans, you need to do something. Although your strategy persists, assume it’s no longer your optimal strategy. Health plans change their benefits, networks of providers, and costs every year. A plan that was great last year could have trimmed its network or adjusted its deductible.
View the health plan brochures on each carrier’s website to see precisely what changed. Not just premium, but actual coverage. See which doctors and hospitals are in each plan’s network, especially if you have preferred providers in Los Angeles or the surrounding areas.
Compare Premiums, Benefits, Deductibles, and Out-of-Pocket Maximums
Premium costs get the initial attention, but they only tell half the story. A more affordable plan might have a higher deductible or out-of-pocket maximum that ends up costing you far more when you do require care. Think about what care you anticipate needing in the coming year. Do you expect regular visits or will specialist care, prescriptions, or procedures be necessary? Include copays for office visits, urgent care, and prescription drugs.
Some people see premium increases of over 200% if they don’t move during open season, whereas others simply get more value by moving to more expensive plans that offer more coverage. The math depends on your particular situation. If you’re healthy with few medical needs, a lower-premium, higher-deductible plan may make sense. If you’re managing chronic issues or have multiple prescriptions, a higher premium plan with low out-of-pocket costs almost always saves you money.
Consider Personal and Family Health Care Needs
Your health picture significantly influences your ideal choice of a federal employee health benefits plan. Check your prescription drugs, routine treatment, and expected care for your eligible family members. If you are covering a single family member, you have the option of either Self and Family or Self Plus One enrollment. Compare premiums between the two, as Self Plus One can sometimes be more expensive than Self and Family.
Stress Timely Enrollment Using OPM’s Online Tools
Use BENEFEDS.gov or your Employee Personal Page (EPP) to make changes to your federal employees health benefits before the December 8 deadline at 11:59 pm Eastern Time. These updates will be effective Jan. 1 or Jan. 11, 2026, depending on the program. If you miss that timing, your existing health insurance coverage rolls over as is, likely locking you into a bad rate or too few benefits for another year.
Conclusion
OPM currently operates a two program arrangement. The 2026 OPM health insurance changes shape plan choice, monthly pay, care rules, and extras. Its impact varies by your occupation, geographic location, and requirements.
Reside in L.A. HMO choices run for miles. A PPO might be more expensive but suits travel. Need insulin, ADHD meds. Look at the drug tiers and prior authorization rules. Be very careful. Peek close at the out of pocket maximum. Not many visits! A low premium with an HSA can still prevail.
Here’s how to stay on track: read your OPM mail, use the plan finder, check your docs, meds, and key costs, and mark the Open Season dates. If you have a quick question, drop it below and we can break it quick. Get an early start to avoid the last minute frenzy.
Frequently Asked Questions
What are the major changes to OPM health insurance for 2026?
OPM health insurance changes for 2026 are here: new coverage rules, higher premiums, and expanded preventive care under the federal employees health benefits program. Important changes include the elimination of coverage for gender transition procedures, mandated coverage for HIV PrEP drugs, and expanded coverage options in certain states for anti-obesity and IVF care.
How much will OPM health insurance premiums increase in 2026?
For 2026, federal employees health benefits will see FEHB enrollee premiums increase by an average of 12.3%, while PSHB enrollees will rise by 11.3%. The government’s maximum contribution for health insurance coverage is $324.76 for Self Only, $711.17 for Self Plus One, and $778.03 for Self and Family per pay period.
What new benefits are included in 2026 OPM health plans?
In 2026, federal employees health benefits plans must include FDA-approved HIV PrEP drugs with zero cost sharing, expanded anti-obesity drug options, and enhanced IVF coverage in states with mandates, alongside improved dental plans offering more routine exams and new pregnancy wellness benefits.
Are there any coverage reductions in 2026 OPM health plans?
Yes, coverage for medical or surgical modification of sex traits, including gender transition procedures, has been removed for all ages in all federal employees health benefits programs starting in 2026.
How do the 2026 changes affect dental and vision coverage?
Dental carriers under the federal employees health benefits program are now required to provide two routine and one emergency exam annually. A handful of carriers introduced preventive care under three and pregnancy wellness, enhancing the health insurance coverage options available for federal employees.
What should I know about the open season for OPM health insurance?
The 2026 federal employees health benefits open season runs from November 10 to December 8, 2025. This is your opportunity to explore different FEHB plans, compare benefits, and make any necessary changes before the upcoming year. Utilize OPM’s handy tools and brochures to assist in your health insurance decision.
How can I compare 2026 OPM health plans?
Use OPM’s official Compare 2026 Plans tool online to explore different FEHB plans. Check out each plan’s brochure for details on federal employees health benefits before your final decision.