Federal Employees Health Benefits (FEHB) Open Season is right around the corner, running from November 11 to December 9, 2024. During this time, FEHB employees can make changes to their health plan for the following plan year.
Many opt to stay with the same health plan year after year, but it is important to reevaluate your options as your needs may change. As a federal employee, you have a unique opportunity to choose from 180 health plans! This Open Season, take the time to review your benefits carefully so you don’t miss out on a better plan that could offer better coverage or save you money. Don’t know where to start? Keep reading to learn what you should look for in a health plan.
Choosing the right health plan can feel overwhelming, but it is important to make sure your coverage matches your current health needs and budget. Here are some features you should consider when choosing a health plan.
In 2025, FEHB enrollees will see the largest health premium increase in over a decade. That said, it is important to find a plan with premiums that fit into your budget.
If you are young, new to the workforce or primarily looking to cover yourself, you may not have many health needs and only use your health insurance for annual preventive care checkups or when you are sick. In this case, consider choosing a plan with a lower premium that still covers essential services, like preventive care, basic prescription drug coverage and emergencies. Basic or Standard plans typically offer lower premiums compared to High Option plans.
If you expect to use your health insurance more frequently, have ongoing medical needs or simply want the peace of mind that comes with a higher level of coverage, consider choosing a plan that has higher premiums but offers more robust coverage when you need it. Plans with higher premiums may also provide better value for pediatric office visits, maternity care and other family healthcare needs. Plus, you may gain access to a wider selection of doctors and hospitals, as well as have lower out-of-pocket costs for co-pays and deductibles. A High Option plan typically has higher premiums, but offers more coverage compared to Basic or Standard plans.
Premiums are not the only cost to consider when choosing a plan. Before your plan begins to pay its share of certain yearly medical expenses, you will need to meet your deductible. Keep in mind, many preventive services and screenings are covered at no cost, without having to meet your deductible.
Plans with higher deductibles generally have lower monthly premiums, making them attractive to individuals or families who do not anticipate needing frequent medical care. However, if an unexpected medical need comes up, you may be expected to pay that higher deductible before your plan begins to pay.
Conversely, plans with lower deductibles tend to have higher premiums, providing more predictable costs for those who expect to use healthcare services regularly.
Ultimately, you will want to choose a health plan with a deductible that aligns with your healthcare needs and comfort level with potential out-of-pocket costs.
Another out-of-pocket cost to keep in mind is copayments — fixed amounts you pay for services like doctor visits or prescriptions, even after meeting your deductible. Depending on how often you utilize your benefits, co-pays can impact your budget differently. Younger, healthy individuals typically don’t visit the doctor often, so co-pays may not be a big concern. However, if you are managing a health condition or aging, more frequent routine visits could mean more frequent co-pays. Understanding how co-pays fit into the plans you are exploring can help you choose one that’s cost-effective for your needs.
There are several types of networks, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS), and Exclusive Provider Organization (EPO). Some health plans allow you to see any doctor, whether they are in-network or not, while others may require you to stay in network for coverage.
At different stages of life, the choice between in-network coverage only or the flexibility to go in or out of network depends on your health needs. If you’re generally healthy and don’t require specialist care, a plan that requires you to stay in-network may be sufficient. These plans typically offer lower premiums, which can be appealing when you are starting your career and may not have major healthcare expenses.
As your health needs increase, the flexibility of a plan that covers out-of-network care can be valuable. You may want the freedom to see specialists or use doctors outside of a plan’s network.
Before choosing a plan, explore the network and coverage it offers. If you like your current providers, check to see whether they are in-network.
Pharmacy benefits are an essential part of the health plan you choose, regardless of what phase of life you are in. These benefits are important for covering occasional prescriptions, like antibiotics or other medications for minor illnesses, as well as vaccines.
Prescription needs often increase as you age, especially if you are managing a chronic condition. Good pharmacy benefits become crucial for those taking multiple medications. Seniors often require more comprehensive prescription coverage to manage their prescription costs.
Prescription plans are typically structured in tiers, with each tier representing different levels of cost-sharing for medications. When comparing plans, look at how each plan categorizes your medications to estimate what you can expect to pay. Keep in mind that plans categorize medications differently and may not cover the same medications. You should also look at what preferred pharmacies are in-network and see whether the plan offers discounts for using mail-order pharmacies.
Comparing plans isn’t just about cost; it's also important to consider the additional perks that are offered, such as wellness programs, discounts on services or access to telehealth options, which can enhance your overall healthcare experience.
Young adults may want to look for plans that offer discounts on fitness memberships or access to virtual visits, which can be a convenient option for busy, early-career professionals. If you have a family, or are planning to start a family, look for incentives for preventive care, such as participation in health and wellness programs. Older adults, or those with Medicare, should look for a plan that maximizes their Medicare benefits with perks like a subsidy for their Part B premium, $0 copays for covered medical services and dental, hearing and vision coverage that’s baked into the plan.
Choosing a health plan is all about considering what is best for you. It's also a balance; do you want the security of a plan with more coverage, even if it means higher premiums? Or would you prefer to pay less in premiums, knowing you may not need extensive coverage throughout the year? These are important questions to ask yourself when evaluating health plans this Open Season.
The Compass Rose Health Plan has three plan options to cover you through each stage of life. For a plan that covers the essentials, consider our Standard Option. Looking for more robust coverage? Explore our High Option. And if you are a retiree with Medicare Part A and Part B, learn more about the advantage of Compass Rose Medicare Advantage. Not sure which plan is right for you? Compare Compass Rose Health Plans side-by-side to see the difference in premiums, out-of-pocket costs, coverage and more.
To help you compare plans between different carriers, the Office of Personnel Management (OPM) has a Plan Comparison Tool that lets you see up to three plans side-by-side.