2026 FEHB Updates Could Change Your Coverage More Than Expected
- 01. 2026 FEHB Plan Updates: What Enrollees Must Know Before January 11
- 02. Premium Increases: The Numbers Behind 2026 Costs
- 03. Discontinued Plans and Automatic Reassignment
- 04. Mandatory Coverage Changes: What OPM Required for 2026
- 05. Prescription Drug Changes: The $2,100 Out-of-Pocket Maximum
- 06. Specific Plan Example: FEP Blue Changes for 2026
- 07. Open Season Timeline and Action Items
- 08. Why This Matters: The Bottom Line for Federal Enrollees
2026 FEHB Plan Updates: What Enrollees Must Know Before January 11
The 2026 FEHB plan updates take effect January 11, 2026 (Pay Period 1), with the average enrollee share of premiums rising 12.3% compared to 2025. Several major plans are discontinuing coverage, including the NALC Health Benefit Plan CDHP and Standard, Alliance HMO Standard, AvMed Health Plan HDHP and Standard, and multiple High Option plans from Blue Care Network of Michigan and Priority Health. Enrollees in discontinued plans must elect a new plan during Open Season (November 10-December 8, 2025) or be automatically enrolled in the default GEHA Benefit Plan-High Option.
Premium Increases: The Numbers Behind 2026 Costs
Federal employees and annuitants face steep premium increases 2026 across the FEHB program. The average enrollee share climbs 12.3% in 2026, down slightly from last year's 13.4% hike but still the second-highest increase in recent history. For context, average increases over the prior three years were 13.5%, 8.7%, and 7.7%.
| Year | Average Enrollee Premium Increase | Year-Over-Year Change |
|---|---|---|
| 2024 | 7.7% | +1.0 percentage points |
| 2025 | 13.4% | +4.7 percentage points |
| 2026 | 12.3% | -1.1 percentage points |
OPM attributes rising costs primarily to higher provider prices and increased utilization of medical services. Despite the average increase, enrollees can often reduce their premium by switching to alternative plans within their area, as the vast majority have multiple options available.
Discontinued Plans and Automatic Reassignment
Multiple plans dropping FEHB 2026 will force enrollees to take action. As of January 1, 2026, the following plans will be discontinued under FEHB:
- NALC Health Benefit Plan CDHP
- NALC Health Benefit Plan Standard
- Alliance HMO Standard
- AvMed Health Plan HDHP
- AvMed Health Plan Standard
- Independent Health High
- Blue Care Network of Michigan High
- Priority Health High
For PSHB enrollees, GEHA Indemnity Benefit Plan Elevate Plus and GEHA Indemnity Benefit Plan Elevate will also be discontinued. Individuals in these plans must select a new plan during Open Season or accept automatic enrollment in a default plan.
- Review your current plan's status on opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/
- Compare at least three alternative plans using the OPM plan comparison tool
- Elect your new plan between November 10 and December 8, 2025
- Confirm enrollment confirmation by mid-December
If you take no action, FEHB enrollees will be automatically moved to the GEHA Benefit Plan-High Option, while PSHB enrollees will be assigned the Blue Cross and Blue Shield Service Benefit Plan-FEP Blue Focus.
Mandatory Coverage Changes: What OPM Required for 2026
OPM mandated several coverage changes 2026 that apply across all FEHB carriers. These federal requirements include both additions and removals:
- Removed: Coverage for medical or surgical modification of sex traits, including gender transition procedures, for all ages
- Added: Required coverage for FDA-approved HIV PrEP drugs and related monitoring with zero cost sharing
- Expanded: IVF coverage in HMO plans located in states with IVF mandates, including retrieval and cryopreservation of sperm/eggs plus at least one year of storage for iatrogenic infertility from non-elective procedures
- Expanded: Behavioral health access with broader networks and out-of-network care when wait times are excessive
- Continued: At least one opioid rescue agent at no cost with expanded safe usage education
- Continued: FDA-approved anti-obesity medications including at least one GLP-1 and two oral options plus behavioral/nutritional programs
"Affected enrollees will have to either elect a new plan in the open season November 10-December 8 or accept enrollment in a default plan." - OPM official guidance on 2026 FEHB/PSHB changes
Prescription Drug Changes: The $2,100 Out-of-Pocket Maximum
A significant drug cost cap 2026 now limits annual out-of-pocket expenses for Part D enrollees. Starting in 2026, there will be a $2,100 out-of-pocket maximum on annual drug costs for those enrolled in Part D. This reform strengthens the drug benefit across all FEHB plans.
Since 75% of the reformed Part D benefit costs are paid through Medicare, FEHB costs reduce for all annuitants who enroll in Part D. Most savings will accrue to currently employed individuals and their agencies since all employees and annuitants share the same cost pool.
Plans will send auto-enrollment letters for Part D, and enrollees have 30 days to disenroll if desired. The FEP Blue Focus plan specifically notes that Medicare Prescription Drug Program availability does not extend to its members.
Specific Plan Example: FEP Blue Changes for 2026
FEP Blue provides a concrete example of how individual plan updates affect enrollees. Key 2026 changes include:
| Benefit Category | 2026 Cost/Requirement |
|---|---|
| Pharmacy out-of-pocket maximum | $2,100 per member |
| Deductible (Self Only) | $750 |
| Deductible (Self Plus One & Family) | $1,500 |
| Catastrophic OOP maximum (Self Only) | $10,000 |
| Catastrophic OOP maximum (Self + One/Family) | $20,000 |
| Maternity facility care copay | $2,500 |
| Emergency room visit copay | $425 |
| Ground ambulance copay | $250 |
| Inpatient admission copay | $425/day (max $2,975/admission) |
FEP Blue now requires prior approval only when patients don't show symptoms or request genetic testing for inheritance risk. Outpatient hospice care no longer requires prior approval. Prenatal care starting in 2025 with birth in 2026 uses 2026 copay amounts.
Open Season Timeline and Action Items
The 2026 Open Season runs from November 10 through December 8, 2025, and is currently underway. This is your only opportunity during the year to make most FEHB changes without a qualifying life event.
Experts recommend that even enrollees happy with current coverage should review options during open season. A notable issue emerging in 2026 is that self-plus-one premiums in several national and regional plans now cost more than family coverage when only one family member needs coverage.
Why This Matters: The Bottom Line for Federal Enrollees
The 2026 FEHB changes represent one of the most significant shifts in recent years, combining steep premium increases, plan discontinuations, and mandatory coverage modifications. The 12.3% average premium increase follows a pattern of rising costs, though it's marginally lower than 2025's 13.4% jump.
Active enrollment during Open Season is critical, especially for those in discontinued plans who face automatic reassignment to potentially different coverage. The mandatory removal of gender transition coverage and addition of PrEP coverage with zero cost sharing reflect broader policy shifts affecting healthcare policy 2026.
Enrollees who proactively compare plans using OPM's comparison tool can often find options that mitigate premium increases while maintaining or improving coverage quality. With the Open Season deadline of December 8, 2025 approaching, now is the time to act rather than wait for automatic reassignment.
Key concerns and solutions for 2026 Fehb Updates Could Change Your Coverage More Than Expected
When do 2026 FEHB changes take effect?
2026 FEHB plan changes become effective January 11, 2026, which is Pay Period 1 of the new year.
What happens if I don't change my FEHB plan during Open Season?
If you don't select a new plan during Open Season (November 10-December 8, 2025), you'll be automatically enrolled in the GEHA Benefit Plan-High Option for FEHB or the Blue Cross and Blue Shield FEP Blue Focus for PSHB.
Which FEHB plans are discontinued in 2026?
Discontinued FEHB plans include NALC Health Benefit Plan CDHP and Standard, Alliance HMO Standard, AvMed Health Plan HDHP and Standard, Independent Health High, Blue Care Network of Michigan High, and Priority Health High.
How much will FEHB premiums increase in 2026?
The average enrollee share of FEHB premiums will increase 12.3% in 2026, compared to a 13.4% increase in 2025.
What new coverage is required for 2026 FEHB plans?
OPM requires all FEHB plans to cover FDA-approved HIV PrEP drugs with no cost sharing, expand IVF coverage in states with mandates, broaden behavioral health networks, and continue covering GLP-1 anti-obesity medications.
What is the new out-of-pocket maximum for prescription drugs in 2026?
The 2026 out-of-pocket maximum for annual Part D drug costs is $2,100 per member.
Can I switch plans mid-year if I'm unhappy with my 2026 election?
No, you generally cannot change FEHB plans mid-year unless you experience a qualifying life event such as marriage, divorce, birth, adoption, or loss of other coverage.