Beyond program-wide mandates, carriers commonly make changes in areas such as coverage and out of pocket costs, details of which are in their plan brochures. Image: JohnKwan/Shutterstock.com
By: FEDweek StaffEven FEHB and PSHB enrollees happy with their coverage should look at their options during a benefits open season, experts advise, to be aware of what is happening with premiums and terms of coverage.
The average enrollee premium in the FEHB is rising 12.3 percent for 2026 over 2025, following average increases of 13.5, 8.7 and 7.7 percent the prior three years. Average increases for 2026 in PSHB plans are 11.3 percent over those this year, the first of its existence.
However, there is variation among plans, and premiums in some are essentially flat or decreasing somewhat.
In addition, enrollees with only one eligible family member to cover in addition to themselves should note that in several national plans and some regional plans under both the FEHB and PSHB, premiums for self-plus-one are more expensive than premiums for family coverage. That anomaly is largely due to a high concentration of retiree couples in self plus one, with higher than average expected claims rates. A family enrollment can be used to cover just two people.
For 2026, across both programs, OPM required carriers to:
- end coverage for medical or surgical modification of sex traits, including gender transition procedures, for all ages;
- cover FDA-approved HIV PrEP drugs and related monitoring, with no cost sharing;
- and broaden networks and allow out-of-network care when wait times are excessive.
Carriers also were required to continue coverage for at least one opioid rescue agent at no cost, with expanded education on safe usage; and for FDA-approved medications for anti-obesity care, including at least one GLP-1 and two oral options, plus behavioral and nutritional programs.
Beyond program-wide mandates, carriers commonly make changes in areas such as coverage and out of pocket costs, details of which are in their plan brochures.
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See also,
Calculating Service Credit for Sick Leave At Retirement
FERS Supplement vs The 10% Pension Bonus
How Your FERS, Social Security and TSP Payments Get Taxed
