FEHB explained: plans, enrollment types and the government share

What the government actually pays

The split is set by law, not by your agency. The government contribution is the lesser of two numbers: 72% of the program-wide weighted average premium, or 75% of the premium for the plan you chose.

That second cap is the part people miss. Below the cap the government covers a full 75% of the premium. Above it, the contribution stops rising and every extra dollar of premium is yours alone. Choose a plan priced well above the program average and you are not splitting that difference with anyone.

The same formula applies to retirees. What changes in retirement is the tax treatment, not the share.

The three enrollment types

• Self Only — you alone.
• Self Plus One — you and one eligible family member.
• Self and Family — you and every eligible family member, at one price no matter how many.

Every FEHB plan offers all three. One quirk is worth a minute of your time: in some plans the Self Plus One premium comes out higher than Self and Family. If you are covering a single dependent, check both prices, because you are allowed to take Self and Family instead. OPM publishes the list of plans where this happens each year.

Eligible family members are a spouse and children under 26, plus an adult child incapable of self-support because of a disability that began before 26. Parents and siblings are never covered.

Plan types, in plain terms

• Fee-for-service with a PPO: go anywhere, pay a lot less inside the network. No referrals. These are the big national plans.
• HMO: a regional network you must stay inside except in emergencies, usually with lower premiums and simpler copays. Only open to you if you live or work in the service area.
• High deductible with an HSA: a low premium and a high deductible, with the plan putting part of its premium into a health savings account you keep and invest, even if you change plans or leave.
• Consumer-driven: similar shape, but the plan funds a reimbursement account that is use-it-or-move-it rather than an HSA you own.

When you can enroll or change

• Newly eligible: 60 days from the day you become eligible.
• Open season: for the 2027 plan year it runs November 9 through December 14, 2026, with changes taking effect in January. The dates follow a fixed rule — the Monday of the second full work week in November to the Monday of the second full work week in December — so they move each year. OPM confirms them in its own announcement each fall.
• Qualifying life events: 60 days to change after marriage, divorce, a birth or adoption, a move out of your plan's service area, or a spouse losing coverage.

If you do nothing, your enrollment continues into the next year automatically at the new premium. The plan's benefits may not be what they were, though. Every plan publishes a brochure section listing what changed, and premium is rarely the only thing that moves.

Premium conversion: the pre-tax part

As an active employee your share of the premium comes out of pay before federal income tax and payroll taxes are worked out, which is worth real money at higher marginal rates. You are in it automatically unless you waive it.

There is one trade-off. Inside premium conversion, you can cancel or drop to Self Only outside open season only when a qualifying life event allows it. Waive premium conversion and you can make those changes any time, but you pay with taxed dollars.

Postal employees: PSHB, not FEHB

Postal Service employees, annuitants and their families are now in the Postal Service Health Benefits Program, a separate program OPM runs with its own plans and premiums. Postal retirees and their covered family members generally have to enroll in Medicare Part B to keep PSHB coverage, with some exceptions for older retirees. If you work for USPS, the FEHB plan brochures and rate tables are not yours to use.

Carrying FEHB into retirement

FEHB is one of the few employer health plans that follows you into retirement at the same government share, but only if you meet the enrollment test: covered continuously for the five years before you retire, or for your whole eligible service if shorter. Miss it and the coverage ends when the job does.

That five-year clock, and the question of what to do when Medicare arrives at 65, are the two biggest FEHB decisions most feds make. Both are covered on our sister site: the five-year rule and the Medicare Part B decision.

What the premium doesn't tell you

Premium is the number you see every payday, so it dominates the choice. The numbers that decide what a bad year costs you are elsewhere in the brochure:

• The catastrophic limit, which is the worst case for the year.
• The deductible and whether it applies before the plan pays anything.
• Whether your doctors and your hospital are in network, checked this year rather than last.
• How your specific prescriptions are tiered, which can differ by hundreds of dollars a month between plans with almost identical premiums.

Add your yearly premium to a realistic estimate of what you will actually use, then compare that total. The cheapest premium and the cheapest year are often two different plans.

Common questions