Federal Health Benefits Guidance After Open Enrollment Ends

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

Open enrollment will end at midnight Monday, meaning federal employees, retirees and some military 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 to your plans for the year ahead.

While most plans are likely to change in some way, whether it’s premium increases, benefit narrowing or the addition of new benefits, few employees choose to change their coverage every year. Experts interviewed by Federal Times said it’s worth at least taking a look at your plan manual to see what’s new.

Choices made during this annual period will affect coverage for the twelve months beginning January 1, 2024.

In total, 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 plan until 2025.

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

Premium increases in 2024

Let’s start with your wallet.

Average insurance premiums for federal employees are expected to increase 7.7% next year. Typically, this fee fluctuates because costs are evaluated each year based on a variety of factors, including the availability of new medical technologies, inflation, prescription drug prices and need for care.

Your premium is a guaranteed fee, so find out exactly how your premium changes.

Kevin Moss, benefits expert at Consumers Checkbook, said of the more than 150 plan options available in 2024, eight have no change in premiums. Premiums became cheaper on 31 plans.

In 68 plans, premiums increased, but by less than 7.7%. About one-third of the plans, or 47 plans, experienced above-average increases.

Plan-wide changes

By 2024, about a dozen plans will exit the federal government’s health insurance program. The largest of these is Humana, but its exit will affect fewer than 10,000 subscribers, according to the Office of Personnel Management.

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

There are also two new plans for 2024 that were not launched last year: Compass Rose Standard and Sentara Health in Northern Virginia.

Keep in mind that if your carrier removes you from coverage, you will need to choose a different plan or you will automatically be enrolled in the lowest-cost plan determined by OPM.

vision and dentistry

While medical costs may skyrocket for some FEHB recipients, vision and dental premiums won’t change much in the coming year.

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

For benefits highlights of the FDVIP program, please click here.

Expanding IVF, Infertility Options

A major theme reported in recent years has been the diagnosis and treatment of infertility. The problem is that some plans have very narrow coverage for artificial reproductive care, which requires some kind of medical intervention to get pregnant.

This year, although all carriers are required to cover three cycles of artificial insemination and in vitro fertilization medications per year, employees should expect that out-of-pocket costs may represent a significant portion of related costs.

Find out which specific operators will expand ART coverage next year.

FEHB and Medicare coordination

Moss said this is a big change to watch out for next year.

Almost half of carriers offer plan options that offer additional benefits and incentives to enrollees in Medicare Part B, the optional portion that covers doctor visits, outpatient services, durable medical equipment and preventive measures.

Next year, Part B will increase by about $10 a month.

About 70% of federal retirees are enrolled in Part B, which means paying two premiums, essentially two duplicate insurance plans, according to Consumers Checkbook.

Experts say it’s worth it for retirees who sign up for Part B and get a FEHB Medicare Advantage plan, which reimburses Part B premiums or waives out-of-pocket costs beyond prescription drugs.

Medicare Advantage plans can also open up Part D coverage to help pay for drug costs. Part D is another voluntary benefit provided by private plans to Medicare beneficiaries.

“We received some notification from OPM in the spring that the Part D reforms were very large,” Moss said. They hope retirees will benefit from it. In fact, it also pushes more of FEHB’s costs onto Medicare plans.

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

Most prescription drug plans will also automatically 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 can be found in Section 9 of each FEHB plan brochure.

Gender Affirming Care

One priority carried over from last year is gender-affirming care, updated to include reducing the number of evaluations required to begin treatment, the medical necessity of facial gender-affirming surgery and hormonal treatments.

Specific coverage can be found in Sections 5(b) and 5(f) of the Plan Manual.

obesity treatment

Just this month, the U.S. Food and Drug Administration approved another weight-loss drug option, joining existing drugs like Ozempic, Wegovy and Mounjaro.

As the therapeutic area expands, OPM said it expects carriers to regularly update their coverage as obesity drugs are approved.

In a January letter to carriers, OPM directed carriers to provide adequate coverage of FDA-approved anti-obesity drugs on formularies.

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

Mental Health

Another ongoing effort this year is that mental health coverage in FEHB plans must adhere to clinical recommendations to screen youth for major depression and anxiety disorders.

OPM also encourages carriers to support the use of telemedicine to improve provider networks.

I’m ready to sign up. What’s next?

OPM provides instructions on how to choose benefits at this link .

Plus, check out advice from experts on how to simplify your decision-making.

Military, Tricare Open Enrollment

If you are a military member and have questions about Tricare health benefits or premiums, check out the MilitaryTimes.com report here.

Molly Weisner is a staff reporter for the Federal Times, covering labor, policy and contracts related to the government workforce. She has worked as a digital producer at USA Today and McClatchy and as a copy editor at The New York Times. Molly majored in journalism at the University of North Carolina at Chapel Hill.

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