FEDweek

Self Plus One Revisited

Last week I wrote about the upcoming FEHB Open Season, and recommended that you assess your own and your family’s current or anticipated health needs so you’ll be able to choose a plan that best meets them. This time I want to focus on an enrollment option that showed up for the first time last year: self plus one.

Self plus one allows you to cover yourself and one eligible family member. The definition of eligible family members is the same as it’s always been. An eligible family member is a spouse or a child up to age 26 or a child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26.

Note: Only legally married spouses are considered eligible family members under any FEHB enrollment category, including self plus one. Thus, domestic partners do not qualify (and neither do their children).

While it was natural to assume that the premium rates for self plus one would be substantially less than those for self and family—that covering two people would be less expensive than covering three or more–it didn’t always turn out that way last year. Many FEHB enrollees were surprised, and even dismayed, to learn that the self plus one option in some plans was only barely less expensive—and in some cases more expensive—than family coverage.

OPM explained that anomaly with the following words:

Q. Why are the enrollee shares for some self plus one enrollments higher than self and family enrollee shares for the same plan?

A. For most enrollees, the enrollee share for self plus one will be lower than the enrollee share for self and family. However, it is possible that some plans will have higher enrollee shares for self plus one enrollments than for self and family enrollments. The statutory formula that is used to calculate the government contribution is based on the average of all plan premiums and requires that OPM calculate a maximum contribution for each enrollment type. In other words, there is a limit to how much the government will contribute towards the cost of a self only, self plus one, or self and family enrollment. The government contributes the lesser of the maximum contribution or 75% of the total premium. The remaining amount is the enrollee share (how much the enrollee must pay). In some cases, such as plans with a premium cost that is above the program average, this calculation may result in a higher enrollee share for a self plus one enrollment than a self and family enrollment.

It’s only logical to assume that the same state of affairs—which to an extent is driven by the predominance of older couples without eligible children in the self plus one population; older people tend to consume more health care—will apply to the 2017 plan year.

Whether you accept OPM’s explanation or not isn’t important. What is important is this: If you are currently enrolled in self and family (and even self only), you should look carefully at the premiums that will be charged in 2017 and decide if it makes sense to change to self plus one.