Opm health insurance plans for retirees 2026
The Office of Personnel Management (OPM) administers health benefits for federal retirees through the Federal Employees Health Benefits (FEHB) program.
As 2026 approaches, let’s check in on updates to these plans.
Your 2026 OPM Health Plan Options
OPM Health Plans for Federal Retirees in 2026
With different areas of coverage, cost, and benefits, these plans offer something to appeal to a variety of health needs and budgets. Knowing the differences between nationwide, regional, high deductible, consumer driven, and enrollment types like Self Plus One will assist retirees in choosing the ideal plan for their situation.
1. Nationwide Plans
Nationwide plans, called Fee-for-Service (FFS) plans, cover you throughout the United States. These are great plans for retirees who travel or have multiple residences. They have a broad network of providers, allowing you to select your own doctors and hospitals.
Although premiums for national plans may be higher than regional ones, they cover out-of-network services as well, which is great for those needing care outside certain areas. For instance, a retiree who resides in Los Angeles but winters elsewhere would want a nationwide plan as it guarantees coverage.
These plans may have copays or coinsurance for out-of-network care, so look at the cost-sharing details of each plan.
2. Regional Plans
As are regional plans, such as HMOs, which restrict coverage to certain areas. These plans typically cost less in terms of premiums and out-of-pocket costs but necessitate using providers that are in the plan’s network.
If you’re a retiree who lives in a fixed location and likes your care to be coordinated, regional plans are often a cost-effective and easy solution. To illustrate, a retiree who permanently lives in Los Angeles can select a regional plan covering California or the West Coast.
These plans focus on preventive care and may require referrals for specialist appointments. It’s a trade-off that means less flexibility in provider choice but often better management of care within a defined network.
3. High-Deductible Plans
HDHPs have lower monthly premiums but higher deductibles. These plans are good if you’re a healthy retiree who doesn’t expect regular medical costs. The higher deductible translates into more out-of-pocket spending up front, but the lower premiums can save you money overall if you don’t have many medical visits.
For example, a retiree without chronic conditions who rarely sees a doctor might opt for an HDHP to minimize their monthly payments. These plans are HSA compatible, so retirees can earmark pre-tax dollars for future medical expenses and provide additional financial planning advantages.
4. Consumer-Driven Plans
Consumer-Driven Health Plans (CDHPs) basically take some attributes of HDHPs and pair those attributes with more active member participation in controlling health care expenses. They tend to come paired with HSAs or comparable accounts, nudging enrollees to shop for value and make savvy choices regarding their care.
They offer a balance of cost and control. For instance, a retiree wanting to stay acutely aware of their health spend might appreciate how a CDHP’s design encourages cost-awareness without compromising coverage excellence.
The fact that this money can be used from HSAs for qualified medical expenses provides flexibility and some tax benefits as well.
5. Self Plus One
The Self Plus One option enrolls the retiree and one eligible family member (spouse or dependent). For some plans, this option may be more expensive than Self and Family coverage, so retirees should carefully compare premiums.
Sometimes it’s less expensive or more efficient to take Self and Family coverage notwithstanding if just one family member actually requires coverage. A retiree covering himself or herself and a spouse should consider the premiums for both types of enrollment before making a decision.
The government pays a defined contribution toward premiums, and a retiree’s portion can differ widely by plan and enrollment type.
Why Open Season Matters More Now
OPM health insurance plans open season in 2026 is more important than ever due to significant premium hikes. Federal employees and retirees are hit with a 9.0 percent average premium hike, up from 6.9 in 2025. This increase translates to increased out-of-pocket expenses, underscoring the importance for enrollees to scrutinize and perhaps tweak their health plans during open season.
It’s smarter to be proactive, which can help you control costs and avoid a later-in-the-year scramble. Our current health care model is very sick-care based. This ‘sick care model’ angers many enrollees since it emphasizes prescriptions and reactive treatments.
The focus is shifting toward a “well care model,” which is the increasing emphasis on preventive care, healthy living, and early intervention. In Open Season, enrollees can seek out plans with superior preventive services or wellness programs to help them stay the course, which may lead to better health outcomes and lower costs over time.
Financial stress mounts for federal workers and retirees. Hundreds of thousands more are taking on second jobs simply to pay for spiking insurance premiums and living costs. This reality is why Open Season is so significant.
It is an opportunity to take a measured look at your options and find that sweet spot between coverage and cost. Choosing a plan that fits your needs can help reduce your financial burden, particularly with premiums and out-of-pocket expenses ranging drastically from plan to plan.
It’s so-called “broken” since it’s focused on pills and procedures, not care. Open Season lets enrollees reconsider their coverage in light of this. They can jump plans to get better coverage for things they really use or to take advantage of new benefits and network changes.
For instance, a few plans are introducing coverage for anti-obesity drugs and bolstered preventive care perks in 2026, which could be more aligned with your personal health requirements. Just 5% or so of enrollees make changes to their plans on an annual basis.
This low rate can leave a lot of people trapped in plans that no longer suit their health or economic circumstances. Open Season is your opportunity to get it right without waiting for a special occasion or paying a penalty. It’s an opportunity cost for richer coverage or savings if you don’t.
Some plans are being discontinued and others are offering new benefits. What is changing for 2026? For example, the Postal Service Health Benefits (PSHB) program will be eliminating plans, and members will have to make an active choice to continue coverage.
New preventive care options and pharmacy out-of-pocket maximums are changing, too. Open Season is the only opportunity to step back and examine these shifts and pick plans that best suit today’s needs. If enrollees don’t choose a new plan during Open Season, they may be defaulted to a plan.
This default likely isn’t the optimal coverage or value for their circumstance. Automatic enrollment can result in more expensive or restricted provider access, which is why it’s important to actively select a plan.
This year’s Open Season is more significant to PSHB members. They have to choose a new plan to maintain coverage in 2026 owing to plan discontinuations. Failing to address this need might even mean losing their health insurance, which is why Open Season is more important for Postal Service retirees.
Projecting Your 2026 Healthcare Costs
Understanding your total monthly premiums for health coverage next year involves examining three key components: the government contribution through federal employees health benefits, your personal expenses, and the role of Medicare Part B in shaping your overall retiree healthcare costs.
Premium Projections
Your premium is your baseline cost. Looking ahead to 2026, the biweekly program-wide weighted average premiums are $451.05 for Self Only, $987.73 for Self Plus One, and $1,080.60 for Self and Family. These figures represent an aggregate growth of 10.2% for the FEHB program and 9.0% for PSHB plans, which include postal service health benefits.
Your own share is rising even quicker, up an average of 12.3% for federal employees participating in the FEHB program. The government subsidy caps at $324.76 biweekly for Self Only, $711.17 for Self Plus One, and $778.03 for Self and Family. On a monthly basis, those caps equal $703.65, $1,540.87, and $1,685.73, respectively.
The difference between what the government pays and the total premium is up to you. If you’re covering an eligible family member, choosing between Self Plus One and Self and Family enrollment is important. Occasionally, Self Plus One comes out to be more expensive than Self and Family, so make sure to review your options during open season.
There are a few reasons why. The FEHB population is older than the average workforce, which tends to increase medical costs. Prescription drugs and standard medical services continue to become more expensive every year. Plan selection is important as well, as some federal employees will experience higher increases than others based on their plan choice and coverage tier.
Out-of-Pocket Reality
Your out of pocket costs extend further than just premiums. Deductibles, copays, and coinsurance vary by plan. A typical office visit could have a $30 copay under one plan but 15 percent coinsurance under another.
Specialist visits, inpatient surgery, and prescription medications all have various cost-sharing. Generic medications at retail pharmacies could cost $85, whereas brand name medications could cost between $85 and $100 depending on your plan.
Knowing this stuff matters since two plans with similar premiums can feel totally different when you actually seek care. Check your plan’s brochure to review what services need prior approval and which ones do not.
Medicare’s Role
If you’re Medicare-eligible, coordination with your federal employees health benefits (FEHB) plan impacts your costs. Your FEHB coverage runs concurrently with Medicare, and who pays first depends on your individual situation and enrollment type.
What Changes Await Retirees in 2026
Here’s what’s in store for federal employees health benefits in 2026. These adjustments range from benefit design to provider networks to prescription drug coverage, including updates to the new pshb program. Thoughtful attention to these elements will be key to staying well covered and in control of expenses. Below are important changes retirees will want to know for the 2026 plan year.
Benefit Adjustments
What’s different for retirees in 2026: select FEHB plans, including the NALC Health Benefit Plan CDHP and Standard, are no longer available. This applies to other plans such as Health Alliance HMO Standard and AvMed Health Plan HDHP. Retirees on these plans need to choose a replacement plan during open season to avoid gaps in coverage, especially since federal employees health benefits are crucial for their well-being.
Dental coverage requirements have expanded: all dental carriers must now provide two routine exams and one emergency exam annually. This shift promotes preventative care access, which can help avoid more expensive care down the line. They must select a new plan for 2026 to remain covered, as numerous existing contracts with dental carriers have either shifted or lapsed.
The government’s maximum monthly contribution toward premiums will rise to $703.65 (Self Only), $1,540.87 (Self Plus One) and $1,685.73 (Self and Family). Premium costs are skyrocketing, with FEHB premiums increasing a whopping 12.3% on average. This will impact retirees’ out-of-pocket costs even as the subsidy increases.
A notable benefit change is the removal of coverage for medical or surgical modifications related to sex traits, including gender transition procedures, in some plans. Retirees relying on these services will need to review their plan details carefully to understand how these policy changes might affect their care.
Retirees not actively changing their 2025 FEHB plan will automatically carry over that coverage into 2026. Given the discontinuations of plans and benefit shifts, it’s wise to review your options and ensure you understand the implications for your federal employees health benefits.
Provider Networks
In 2026, the provider networks of the FEHB and PSHB plans underwent significant changes. With six FEHB plans dropped, the options for federal employees have shrunk, limiting regional and national network choices. Retirees may find that their usual doctor or facility is no longer in network under their existing federal employees health benefits plan, leading to higher costs or the necessity to switch providers. The number of FEHB carriers remains stable at 47, offering 132 plans, while PSHB will feature 17 carriers with 75 plans.
Additionally, the FEDVIP dental and vision insurance program options have diminished, with fewer than a dozen carriers available. These adjustments mean that retirees must be proactive in confirming their favorite providers are still included in the new networks. As the network size and composition evolve, retirees in areas affected by discontinued plans might lose access to specialized care.
It is crucial to ensure that new PSHB plans adequately cover necessary specialists or hospitals to avoid unexpected out-of-network fees. Retirees should carefully review their health plan brochures to understand the coverage changes and ensure they have access to essential care.
Prescription Coverage
Prescription drug coverage continues to change in 2026. The majority of plans have implemented or kept an annual pharmacy out-of-pocket maximum of $2,100 per member to assist in capping medication prices. Many carriers are covering a wider range of FDA-approved drugs, from preventive medications for chronic conditions like obesity to HIV PrEP drugs, usually without any cost sharing.
With rising overall healthcare costs comes higher premiums and copays for certain medications. Retirees must examine their formulary lists closely to confirm their key medications are still included.
Dental and vision plans through FEDVIP have expanded preventive benefits such as coverage for children under age three and pregnancy wellness. These do not affect retirees.
FEDVIP plan specifics for 2026 will be published on official government sites in early November, allowing retirees to evaluate their options ahead of enrollment deadlines.
How to Enroll or Change Your Plan
In 2026, Medicare-eligible federal employees must navigate specific windows and methods to enroll or change their plans under the OPM Health Insurance program. These sections provide guidance on gathering necessary facts, comparing federal employees health benefits, and submitting enrollment changes to ensure the selected coverage meets their healthcare needs and budget.
Gather Information
The initial step is to gather specific information regarding health insurance plans, particularly the federal employees health benefits available during the open season. This period runs from mid-November through December 8th each year, with 2025’s dates set for November 10 to December 8. During this window, retirees may enroll in or change their FEHB plans for the upcoming year. However, those outside this timeframe can only make changes if they experience a Qualifying Life Event, such as moving out of their plan’s service area or other significant life events.
Retirees can view plan information in multiple ways, as OPM has extensive resources online, including plan brochures, premium rates, and a state-specific comparison tool. For instance, OPM’s site allows you to click on your state and see the full roster of available plans, including postal service health benefits and their specifics. A review of these materials will help you better understand the types of coverage available, such as Self Only, Self Plus One, or Self and Family, along with premiums and benefits.
It’s wise to keep your anticipated health care needs for the new year in mind as you collect this information. Consider future doctor’s visits, prescriptions, and medical procedures to choose a plan that strikes the right coverage versus cost trade-off. Reviewing any changes from last year, such as plan benefits, premiums, or service areas, ensures you stay informed about how your current plan might be changing.
Compare Plans
Once you’re informed, take a close look at your plan options. Your plan may not be the same year to year, as certain carriers may drop out of the federal employees health benefits (FEHB) program or scale back their service areas. This is why it becomes even more important to compare plans. OPM’s amazing comparison tools let you compare benefits, out-of-pocket costs, provider networks, and premiums side by side.
When comparing, think about things like coverage for certain treatments, access to your favorite doctors, and prescription drug benefits. For example, certain plans may offer enhanced benefits such as fertility services or HIV PrEP medications with no cost sharing. Consider how premiums work in your budget, particularly as Self Plus One enrollment can occasionally be more expensive than Self and Family coverage, especially with postal service health benefits.
Remember, the effective date for any Open Season enrollment or plan change is January 25, 2026. Until then, your existing plan insures you, so you have the breathing room to choose wisely without losing coverage. Comparing plans inside and out keeps you from surprises and makes sure your healthcare needs will be covered in the year ahead.
Submit Changes
When you’ve decided on a plan, enrolling or submitting your change request is the next step. During Open Season, retirees have a number of options for submitting changes. You may enroll or update your plan online through systems provided by your agency or OPM’s website. Alternatively, you can simply call Open Season Express at 1-800-332-9798 to change over the phone. For those looking into postal service health benefits, this process is equally straightforward.
If paper is more your style, you can submit a Standard Form 2809, Employee Health Benefits Election Form, to your HR/Retirement Office. If you use this method, state your Open Season request clearly, including the name of the plan and type of coverage (Self Only, Self Plus One or Self and Family) and your Social Security or annuity claim number. If covering family members, enter their information as requested to ensure proper federal employees health benefits coverage.
Once submitted, changes are effective January 25, 2026. Your old carrier provides coverage through January 24. If you need help enrolling or have questions, resources such as the Retirement Information Office (1-888-767-6738) or online support are available, especially for inquiries related to the new pshb program.
Beyond the Brochure: A Retiree’s Perspective
They come to retirement with decades of habit, not recent shopping. Some of us haven’t dealt with a health insurance decision in 30 or 40 years, and now there’s this brand new mind-bender. The system they recall is no longer the case federally. What used to cover most needs under one plan now varies by federal employees health benefits, premiums, networks, and out-of-pocket rules.
Anticipate re-learned jargon and a side-by-side comparison of figures that affect your life, now. Start by checking basic plan math: premiums, deductibles, copays, coinsurance, and the catastrophic limit. For instance, a low-premium plan may appear inexpensive until you face a $2,000 deductible and 20 percent coinsurance for specialist visits.
A plan with a higher monthly premium might cap out-of-pocket exposure more quickly. Look at actual use: if you visit a cardiologist twice a year and need imaging, run those costs across plan tables to see real differences. Don’t forget pharmacies. Drug tiers and mail-order rules can change yearly costs a lot, especially under the postal service health benefits program.
Medicare timing is important. About 20% of retirees maintain federal coverage and defer Medicare Part B at age 65. That’s fine for some, but you need to contemplate penalties and secondary payer rules. If you delay Part B, verify how your FEHB or other federal plan pays primary or secondary.
For those who have Part B, verify coordination of benefits and if enrolling alters premium subsidies or out-of-pocket exposure. Conducting your selections during Open Season speaks volumes. Approximately 95% of federal employees and retirees do not switch plans during Open Season. That momentum can keep folks stuck in plans that no longer suit.
Your needs might have changed. New chronic conditions, provider networks have changed, or you have moved to Los Angeles where some plans have superior hospital access. Revisit your decision every year, not every few years. Administrative measures are functional and necessary. Submit a health benefits election with your retirement paperwork when applicable, so your elections can kick in post-separation.
Check with your human resources office or the OPM for forms and deadlines. Use OPM’s plan comparison tools, call plan customer service lines to get network lists, and check Medicare.gov for Part D and Medigap options. Anticipate bafflement and pursue illumination. Talk with others who retired recently, use federal benefits counselors, and scenario test with actual cost examples.
Retirement changes a lot, so should how you select health coverage.
Conclusion
OPM 2026 plans have obvious trade-offs. Few plans trim monthly costs. Certain plans eliminate out-of-pocket sting. Choose by comparing premiums, drug tiers, copays, and which hospitals are in-network. A retiree in LA who visits heart or cancer specialists might choose a plan that covers Cedars-Sinai and UCLA Health. A retiree on a strict fixed income might select the plan with a low premium and local clinics. Open Season dates make the regulations. Miss the window and choices decrease. Collect your bills, drug list, and compare at a minimum three plans side by side. Go to OPM.gov/insure or call your plan rep to compare and enroll before the deadline.
Frequently Asked Questions
What OPM health plan options will be available to retirees in 2026?
OPM offers federal employees health benefits through various FEHB plans, including fee-for-service, HMOs, and high-deductible consumer-driven options, with availability varying by ZIP Code.
When is Open Season and why does it matter for retirees?
Open Season, which takes place in November to December, is the once-a-year opportunity for federal employees to join or switch their FEHB coverage without a qualifying event. Confirm specific 2026 dates on opm.gov.
How does Medicare interact with my FEHB coverage in 2026?
If you’re a federal employee and Medicare-eligible, sign up for Parts A and B when eligible. Medicare typically pays first, and the federal employees health benefits (FEHB) program could pick up the rest in accordance with plan rules.
How can I estimate my 2026 healthcare costs as a retiree?
Rates for federal employees’ health benefits differ based on the plan, level of enrollment, and in some locations. Anticipate a few rate hikes. Utilize OPM’s plan comparison tools and each insurer’s 2026 premium tables to calculate your out-of-pocket expenses.
What major changes should retirees expect in 2026?
Anticipate premium tweaks, benefit modifications, and potential network shifts in federal employees health benefits. Telehealth and mental health options could shift. Read each plan’s 2026 brochure for specific changes.
How do I enroll or change my FEHB plan as a retiree?
During Open Season, federal employees can sign up or change their coverage through OPM Retirement Services or their retirement agency. For additional information, submit forms online or by mail and reach out to your plan’s customer service for assistance.
Where can Los Angeles retirees get free, local help?
Utilize OPM Retirement Services and California’s HICAP for free advice on federal employees health benefits. Your agency’s retiree office or union can provide customized assistance.