Retirement & Financial Planning Report

The three levels of FEHB are self only, which provides benefits only to the enrollee; self plus one, which provides benefits to the enrollee and one eligible family member; and self and family, providing benefits to the enrollee and all eligible family members. These enrollment levels may be changed during an open season, or outside of an open season due to certain life events as described below, so long as the change is consistent with the event.

An enrollee with more than one eligible family member may enroll in self plus one and would have to designate the second person to have coverage, but that would mean that any other family member would have to get health coverage elsewhere.

Also, the second person can be changed during an open season or due to certain life events, although also only if consistent with the event. For example, an enrollee with a spouse and one eligible child and who is insuring only the child could switch coverage to the spouse if the child hits the age 26 cutoff for coverage. (Note: The carrier may request documentation to prove the eligibility of the newly designated family member.) However, if a childless couple has or adopts a child, the enrollee could not switch coverage from the spouse to the child—in that case the enrollee could switch to family coverage.

Choosing the self only option isn’t just for someone who is either unmarried and/or has no eligible children. It’s also a potential option for married couples. In some cases both work for the federal government and have an entitlement to enroll in the FEHB program on their own. One attraction of having separate coverage is that it allows each of them to tailor their plan selection to their specific needs.

Another is that there are times when the premium cost of two self only enrollments will be less than that for one self plus one or one self and family enrollment. However, it needs to be kept in mind that each enrollee would have to meet the co-insurance and deductible requirement plus the catastrophic limit on his or her own. Also, one of the enrollees would have to elect a self plus one or self and family plan to obtain coverage for any eligible child or children.

There are also situations where one of the spouses has a job outside the federal government and where coverage is provided at little or no cost, at least for self-only enrollment. In such cases it might make sense to have two self-only plans—or, if there is one eligible child, one self-only and one self plus one enrollment.

However, it’s not uncommon for employees retiring from non-federal jobs to lose their health benefits coverage or have it substantially reduced. It also happens when they get laid off. Also, while it’s easy to switch to self plus one or to self and family coverage during an open season, it would be impossible if you were to die before doing so. If that happened, your widow(er) (and children, if any) wouldn’t be eligible for FEHB coverage.

Another possibility is for the federal spouse to be covered under the non-federal spouse’s plan and not enroll in the FEHB at all. If that non-federal coverage were to suddenly end, both could be left without health insurance, although possibly with rights for temporary continuation with no employer share of the premium. If you were a federal employee, you could enroll during the next open season.

Also remember that in most cases you’d have to be enrolled in the FEHB program for the five consecutive years before you retired to be eligible to carry that coverage into retirement. If you were a retiree when that non-federal coverage ended, you wouldn’t be eligible to enroll in the FEHB program.

Note: A court order such as a divorce decree could impact an enrollee’s freedom of choice among the options by mandating coverage for a child/children, and potentially also the choice of plans if the enrollee lives in a different area than the child/children.