Key Takeaways:
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Choosing the right FEHB plan during Open Season requires a detailed review of coverage, costs, and benefits to ensure it aligns with your healthcare needs in 2025.
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Understanding the impact of plan changes, Medicare coordination, and long-term affordability can help you make an informed decision that supports your health and financial well-being.
Are You Maximizing Your FEHB Plan Selection?
The Federal Employees Health Benefits
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The key to making a smart choice is understanding how your plan’s benefits, costs, and provider network align with your healthcare needs. Taking a proactive approach during Open Season ensures that you aren’t stuck with unexpected expenses or gaps in coverage. Since healthcare costs continue to rise, it’s more important than ever to evaluate your FEHB plan carefully.
Here are seven critical questions you should consider when reviewing your FEHB plan options for 2025 Open Season.
1. Has Your Plan Changed Its Premiums, Deductibles, or Copayments?
One of the most important aspects of reviewing your FEHB plan is understanding how premiums, deductibles, and copayments have changed from last year. Even small increases in costs can add up significantly over time, impacting your financial planning for healthcare expenses.
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Premium Adjustments: In 2025, FEHB premiums have increased by an average of 11.2%, with enrollees paying about 13.5% more on average. This means you may be paying hundreds more per year for the same coverage.
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Deductibles & Copayments: These costs vary by plan and may have changed, affecting your out-of-pocket expenses for doctor visits, hospital stays, and prescriptions.
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Affordability in Retirement: If you are nearing retirement, consider how fixed-income adjustments may impact your ability to afford your plan in the long run. Since retirees often have fewer income sources, a plan that is affordable now may become a burden in the future.
It’s essential to compare last year’s costs with the new rates to determine whether your current plan still fits within your budget. Reviewing these costs will also help you identify if switching to a different plan could save you money.
2. Does Your Plan Still Cover the Providers and Facilities You Use?
Your preferred doctors, hospitals, and specialists may no longer be in-network with your current FEHB plan. During Open Season, review your plan’s network coverage to ensure your preferred providers remain included.
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Network Updates: Some plans modify their provider networks annually, affecting access to specific healthcare facilities. A hospital or doctor that was covered last year may now be out of network, leading to increased costs or the need to switch providers.
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Out-of-Network Costs: If your preferred doctor is now out-of-network, you could face significantly higher out-of-pocket expenses. Out-of-network care can sometimes be twice as expensive as in-network services.
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Specialist Referrals: If you frequently visit specialists, confirm that they are still covered under your plan to avoid unexpected costs. Some plans require referrals or impose higher copayments for specialist visits.
Checking provider directories can save you from surprise medical bills in 2025. If you find that your preferred healthcare providers are no longer covered, it may be time to switch plans.
3. Have Your Prescription Drug Costs Increased?
Prescription drug coverage is a major factor when selecting an FEHB plan, especially if you rely on regular medications. Drug costs can fluctuate significantly depending on your plan’s formulary and cost-sharing structure.
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Formulary Changes: Some plans may remove medications from their covered drug lists or reclassify them into a higher-cost tier. If your medication moves to a non-preferred tier, you could be paying more out-of-pocket.
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Copay & Coinsurance Updates: The cost you pay for medications could increase, even if your plan remains the same. A slight increase in copayments could result in hundreds of extra dollars per year for necessary medications.
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Medicare Coordination: If you are eligible for Medicare, check whether your FEHB plan offers Part D Employer Group Waiver Plan (EGWP) integration, which could reduce costs.
Reviewing the prescription drug list before Open Season ends can help prevent unexpected pharmacy expenses next year. If your medication is no longer covered or has become more expensive, it might be worth switching to a plan with better drug coverage.
4. Are There New Plan Options That Better Fit Your Needs?
FEHB introduces new plan options and modifications each year. Some plans may offer new benefits, while others may discontinue coverage or reduce offerings.
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High-Deductible Health Plans (HDHPs): These plans may offer lower premiums but require higher upfront costs before coverage kicks in. If you rarely need medical care, this could be a cost-saving strategy.
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Standard vs. Basic Options: Some plans provide multiple tiers of coverage—compare which level offers the best value for your needs.
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Enhanced Benefits: Certain plans may now include wellness incentives, telehealth coverage, or preventive care enhancements.
Comparing new offerings could result in a plan that better matches your healthcare and financial situation. It’s important to look beyond premiums and consider the total cost of healthcare, including deductibles and copays.
Making an Informed Choice for 2025
Selecting an FEHB plan is more than just comparing premiums—it requires careful evaluation of coverage, costs, provider networks, and future healthcare needs. Open Season only lasts from November 11 to December 13, 2025, so use this time wisely to compare plans, verify benefits, and make any necessary changes.
If you need personalized assistance, get in touch with a licensed agent listed on this website who can help you understand your options and make the best choice for your healthcare and financial needs.
