In the FEHB, there will be 42 participating carriers offering 64 plans and a total of 130 plan options, while in the PSHB, there will be 30 carriers offering a total of 69 plan options. Image: The Image Party/Shutterstock.com
By: FEDweek StaffThe announcement of premium rates in the FEHB and the newly launched Postal Service Health Benefits program ahead of the open season that will run November 11-December 9 underscores both the similarities and differences between those two programs.
One major difference is the number of plans and options available. In the FEHB, there will be 42 participating carriers offering 64 plans and a total of 130 plan options. In the PSHB, there will be 30 carriers offering a total of 69 plan options, including national fee-for-service plans and major city area HMOs accounting for the large majority of FEHB enrollees.
Postal Service employees and retirees currently enrolled in one of those plans will be automatically enrolled in the parallel PSHB plan if they make no change in the upcoming open season. There has been no accounting of the number of enrollees in FEHB plans that will have no parallel PSHB plan; enrollees in those who make no choice in the open season will be enrolled by default in the lowest-cost national PSHB plans.
The 2022 law ordering the PSHB into existence requires that carriers offering PSHB plans generally must offer benefits and cost-sharing equivalent to the benefits and cost-sharing for FEHB plans for that carrier in the initial contract year. However, there are no such requirements for years after 2025.
One exception is that in the PSHB, prescription drug coverage for retirees and their covered family members is integrated with Medicare through a process called Employer Group Waiver Plans EGWPs.
Further, those retiring from the Postal Service after this year generally must be enrolled in Medicare Part B to be eligible for coverage under the PSHB. That does not apply to those retired before the end of this year, to current USPS employees who are age 64 or older before the end of this year, nor to future retirees living overseas or who are receiving care through the VA or Indian Health Service.
A “special enrollment period” that had started in April allowing current postal retirees who had not enrolled in Medicare Part B to join that program without paying the surcharge that typically applies to those who delay past their initial eligibility ended Monday (September 30).
The Medicare integration feature of PSHB in effect shifts some costs of retirees from the FEHB program onto that program. That contributed to the difference in the average enrollee premium increase for PSHB plans carrying over from the FEHB vs. plans within the FEHB, 11.1 vs. 13.5 percent. Demographic differences—with resulting differences in health insurance claims rates—between the postal and non-postal populations also contributed to that difference.
In both programs (plans and options here), there will be expanded benefits in 2025 compared to current FEHB coverage for in-vitro fertilization, anti-obesity medication, maternal health and mental health and substance abuse treatment.
2025 FEHB and PSHB: Similarities and Differences
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See also,
FERS Supplement vs The 10% Pension Bonus
The TSP Rollercoaster vs. the G Fund Merry-Go-Round
How Children’s Eligibility Changes Across Federal Benefits
