While the holiday shopping season is in full swing, the marketplace for federal employee health benefits is getting ready to close up shop for the season.

Open enrollment ends at midnight on Monday, meaning federal employees, retirees and some military service members won’t have another chance to change their benefits until next year. Now is the time to review your coverage, weigh competing plans and make adjustments for the plan year ahead.

Very few employees elect to change their coverage each year despite the fact that most plans likely changed in some way, whether premiums went up, benefits narrowed or new perks were added. Experts interviewed by Federal Times said it’s worth at least scanning through your plan brochure to see what’s new.

Selections made during this annual period will affect coverage for twelve months beginning on Jan. 1, 2024.

In all, more than 8 million people are covered by the program each year, including U.S. Postal Service workers who won’t be covered by their own unique program until 2025.

Federal Times has been tracking major policy changes affecting plans this year to help you navigate options and save time.

RELATED

2024 premium increases

Let’s start with your wallet.

The average federal employee can expect to pay 7.7% more on insurance premiums next year. It’s customary for this to fluctuate, as costs are evaluated annually based on several factors, including the availability of new medical technology, inflation, prescription drug prices and demand for care.

Your premium is a guaranteed expense, so figure out exactly how yours is changing.

Of the more than 150 plan options available in 2024, eight had no change in their premiums, according to Kevin Moss, a benefits expert at Consumers’ Checkbook. Premiums got cheaper for 31 plans.

In 68 plans, the premium increased, but by less than 7.7%. About a third of plans, or 47 of them, increased above the average.

RELATED

Program-wide changes

There are about a dozen plan options leaving the federal government’s health insurance program in 2024. One of the largest is Humana, though its departure will affect fewer than 10,000 subscribers, according to the Office of Personnel Management.

Here’s a complete list of which plans are leaving the program or dropping coverage for certain areas.

There are also two new plans in 2024 that weren’t available last year: Compass Rose Standard and Sentara Health in northern Virginia.

Remember that if your carrier is dropping you from coverage, you’ll need to select a different plan, or else you’ll be auto-enrolled in the lowest cost plan as determined by OPM.

Vision and dental

While medical costs may soar for some FEHB enrollees, vision and dental premiums will change little in the year ahead.

The average premium increase is 1.4% for dental plans and 1.1% for vision.

For benefits highlights under the FEDVIP program, click here.

Expanded options for IVF, infertility

A major theme of coverage in recent years has been diagnosis and treatment of infertility. The issue is that some plans have very narrowly granted coverage for artificial reproductive health care, which requires some kind of medical intervention to conceive a baby.

This year, employees should still expect to pay a potentially large share of their associated costs out-of-pocket, though all carriers are being required to cover artificial insemination drugs and drugs for in vitro fertilization for three cycles per year.

See which specific carriers are expanding ART coverage next year.

FEHB and Medicare coordination

This is a significant change for next year to be aware of, said Moss.

Almost half of all carriers offer plan options that provide additional benefits and incentives for those under Medicare Part B, the optional portion that covers doctor visits, outpatient services, durable medical equipment and preventatives.

For next year, Part B is going up by about $10 a month.

“About 70% of federal retirees enroll in Part B, which means paying two premiums and in essence two duplicative insurance programs,” according to Consumers’ Checkbook.

It’s worth it, experts said, for retirees who join Part B and get access to FEHB Medicare Advantage plans that can reimburse Part B premiums or waive out-of-pocket medical expenses outside of prescription drugs.

Medicare Advantage plans can also open up Part D coverage to assist with drug costs. Part D is another voluntary benefit for beneficiaries of Medicare provided by a private plan.

“We were getting some notice from OPM in the spring that the Part D reforms were something that were really big,” Moss said. “They wanted retirees to benefit from this. And really what it’s also doing is pushing more of the FEHB costs onto the Medicare program.”

RELATED

A total of 39 plans will offer Medicare Advantage or Medicare Part D plans that automatically coordinate with FEHB coverage.

Most prescription drug plans will also auto-enroll you if you have Medicare Parts A and B or just Part A, Moss said. However, you can choose to opt-out.

Medicare information is found in Section 9 of each FEHB plan brochure.

Gender-affirming care

A priority that was rolled over from last year, gender-affirming care, was updated to include a reduction in the number of required evaluation letters for initiation of treatment, medical necessity of facial gender-affirming surgery and hormone therapy.

Specific coverage can be found in Sections 5(b) and 5(f) of plan brochures.

Obesity treatment

Just this month, the Food and Drug Administration approved another weight-loss drug option alongside existing medications like Ozempic, Wegovy and Mounjaro.

As the landscape for treatments broadens, OPM said it expects carriers to regularly update their coverage of obesity drugs as they become approved.

In its letter to carriers in January, OPM directed carriers to “have adequate coverage of FDA approved anti-obesity medications on the formulary.”

This year, carriers have new coverage requirements for these drugs and for screening and prevention efforts.

Mental health

Another continued effort this year, mental health coverage by FEHB plans must adhere to clinical recommendations to screen youth and teens for major depressive disorder and anxiety.

OPM also encouraged carriers to support the use of telehealth in improving provider networks.

I’m ready to enroll. What’s next?

OPM has instructions for how to choose your benefits at this link.

Plus, check out these tips from experts on how to streamline your decision-making.

Military personnel, Tricare open enrollment

If you’re a military service member and have questions about your Tricare health benefits or your premium costs, check out MilitaryTimes.com coverage here.

Molly Weisner is a staff reporter for Federal Times where she covers labor, policy and contracting pertaining to the government workforce. She made previous stops at USA Today and McClatchy as a digital producer, and worked at The New York Times as a copy editor. Molly majored in journalism at the University of North Carolina at Chapel Hill.

Share:
In Other News
Load More