Federal Employees Health Benefits Program
The Federal Employees Health Benefits Program (FEHBP), commonly referred to as FEHB, is a voluntary health insurance initiative administered by the U.S. Office of Personnel Management (OPM) that delivers comprehensive medical coverage to eligible civilian federal employees, retirees, former employees receiving annuities, and their dependents.[1] Established under the Federal Employees Health Benefits Act of 1959 and operational since 1960, the program enrolls over 8 million participants across approximately 180 private-sector health plans, including fee-for-service, health maintenance organizations (HMOs), and high-deductible consumer-driven options, fostering a competitive marketplace where enrollees select coverage tailored to their needs.[2][3] The federal government subsidizes a significant portion of premiums—typically around 72% on average for self-plus-family coverage—while requiring employees to contribute the remainder, with no exclusions for pre-existing conditions and guaranteed renewability for those remaining federally employed or retired.[4][5] Key to FEHB's structure is its emphasis on managed competition among private carriers, which negotiate benefits and rates annually under OPM oversight, enabling cost containment through enrollee choice and plan innovation rather than centralized price controls.[6] This model has sustained broad preventive and essential services, such as immunizations, cancer screenings, and prescription drug coverage, while maintaining relatively stable per-enrollee spending growth compared to broader private-sector trends over decades.[6][7] Enrollment occurs during annual open seasons or qualifying life events, with seamless portability into retirement for those with at least five years of service, distinguishing it as the nation's largest employer-sponsored health program by participant volume.[1] Despite these attributes, FEHB has encountered challenges, including persistent premium escalations—projected to rise by 6-8% for many plans in recent years due to medical inflation and utilization—and administrative vulnerabilities to fraud, as evidenced by staffing shortages at OPM impeding risk assessments and claim audits.[8][9] Historical analyses have noted episodes of adverse selection, where sicker enrollees gravitate toward richer plans, prompting periodic benefit standardizations, though the program's decentralized design has generally mitigated single-payer inefficiencies observed elsewhere.[10] Overall, FEHB exemplifies a hybrid public-private framework that prioritizes consumer-driven competition, yielding empirical advantages in plan variety and administrative flexibility over fully government-operated alternatives.[11]Historical Development
Establishment in 1960
The Federal Employees Health Benefits Program was created through the Federal Employees Health Benefits Act of 1959 (Public Law 86-382), signed into law by President Dwight D. Eisenhower on September 28, 1959.[12] This legislation established a voluntary, government-wide health insurance system for federal civilian employees, addressing the patchwork of limited coverage options previously available, which often included agency-specific or individual policies lacking standardization.[13] The Act authorized the Civil Service Commission—later succeeded by the Office of Personnel Management—to negotiate contracts with private insurance carriers to offer comprehensive benefits, including inpatient and outpatient hospital care, surgical services, and physician visits, while prohibiting discrimination based on age, sex, or preexisting conditions.[2] The program became effective on July 1, 1960, coinciding with the start of the first applicable pay period, and initially covered approximately 2.2 million eligible federal employees and their dependents out of a total federal civilian workforce of about 2.5 million.[3] [14] Enrollment was structured to allow employees a choice among competing plans, with the government contributing up to 50% of premiums (capped at a specified amount) and employees covering the balance through payroll deductions.[2] This cost-sharing model, funded via a centralized FEHBP fund managed by the Civil Service Commission, aimed to leverage economies of scale for better rates and broader coverage than private market options available to federal workers at the time.[15] At launch, the program featured a limited selection of nationwide carriers, including service benefit plans like Blue Cross and Blue Shield, alongside employee organization plans and high-option comprehensive coverage, marking the first major federal initiative to provide retiree health benefits alongside active employee coverage under uniform standards.[15] By the end of the first enrollment period in 1960, participation rates exceeded 50% among eligibles, reflecting demand for the program's portability and nondiscriminatory features amid rising postwar healthcare costs.[14] The establishment positioned FEHBP as a benchmark for employer-sponsored insurance, influencing subsequent private sector practices while remaining exempt from state insurance regulations to ensure nationwide uniformity.[16]Key Expansions and Legislative Changes
The Federal Employees Health Benefits Program underwent initial legislative refinements in the 1960s and 1970s to clarify eligibility for survivors and annuitants, incorporating provisions for continued coverage upon the death of an enrolled employee.[2] These changes, embedded in amendments to Chapter 89 of Title 5, U.S. Code, ensured that family members could maintain enrollment under specific circumstances, such as immediate family coverage for survivors receiving annuities.[17] A major eligibility expansion occurred with the Civil Service Retirement Spouse Equity Act of 1984 (P.L. 98-615), which permitted certain former spouses of federal employees or annuitants to enroll in or continue FEHB coverage if the marriage lasted at least 10 years during federal service.[18] In 1986, the Federal Employees' Retirement System Act (P.L. 99-251) introduced temporary continuation of coverage, enabling eligible separated employees—such as those involuntarily terminated or divorced—to extend FEHB enrollment for up to 18 months by paying the full premium plus a 2% administrative fee.[19] These measures addressed gaps in continuity for non-retirees, increasing access without altering core plan structures. Subsequent changes focused on benefit equity and family coverage. The Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343) mandated that FEHB plans apply equivalent financial requirements and treatment limitations to mental health and substance use disorder benefits as to medical/surgical benefits, building on earlier limited parity efforts from the 1990s.[10] The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) further expanded dependent eligibility, allowing unmarried children under age 26—including students and non-students—to remain on parents' FEHB plans regardless of tax dependency status, with provisions for married children in certain cases; this change boosted enrollment among young adults.[6] More recently, the Postal Service Reform Act of 2022 (P.L. 117-108) established the separate Postal Service Health Benefits Program effective January 1, 2025, transitioning approximately 800,000 U.S. Postal Service employees and retirees out of FEHB while maintaining similar structures and carrier options.[20]Evolution Through the 21st Century
In the early 2000s, the Federal Employees Health Benefits Program (FEHBP) underwent adjustments to enhance coverage equity and administrative efficiency. The Federal Employees Health Benefits Children's Equity Act of 2000 (P.L. 106-394) extended eligibility for dependent children coverage to unmarried children under age 26 who were full-time students or incapable of self-support due to mental or physical incapacity, broadening family protections beyond prior age limits.[21] Concurrently, regulations implemented premium conversion under Section 125 of the Internal Revenue Code, allowing federal employees to pay FEHBP premiums with pre-tax dollars effective January 1, 2001, which reduced taxable income for enrollees while maintaining program funding stability.[22] These changes coincided with rising premiums, averaging 9.3% in 2000 amid broader healthcare cost inflation, prompting oversight to balance carrier profitability and enrollee affordability.[23] Mid-decade developments emphasized benefit standardization and parity. The Office of Personnel Management (OPM) introduced consumer-driven health plans (CDHPs) in 2006, featuring high-deductible options paired with personal health savings accounts or health reimbursement arrangements, aiming to incentivize cost-conscious behavior among enrollees while expanding plan variety to over 200 options by the late 2000s.[3] A pivotal legislative shift occurred with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, P.L. 110-343), which mandated FEHBP plans to eliminate disparities in financial requirements (e.g., copayments, deductibles) and quantitative treatment limitations between mental health/substance use disorder benefits and medical/surgical benefits, effective for plan years beginning on or after October 3, 2009; OPM guidance ensured compliance without increasing overall premiums disproportionately.[24][25] The Affordable Care Act (ACA, P.L. 111-148) of 2010 largely exempted FEHBP from mandates like essential health benefits packages and individual/community rating requirements, preserving its competitive, employer-sponsored model and multi-plan structure; however, certain provisions applied, including prohibitions on lifetime/res annual dollar limits and requirements for preventive services without cost-sharing, which OPM integrated via carrier negotiations to minimize disruptions. Enrollment grew steadily, reaching approximately 8.3 million beneficiaries by the 2020s, reflecting federal workforce stability and retiree participation.[3] The Bipartisan Budget Act of 2013 (P.L. 113-67) introduced a "self plus one" enrollment tier, allowing coverage for employees and a single family member, which increased flexibility and contributed to administrative efficiencies in premium calculations.[26] A significant structural evolution emerged with the Postal Service Reform Act of 2022 (P.L. 117-108), establishing the Postal Service Health Benefits (PSHB) Program as a separate entity within the broader FEHB framework, effective January 1, 2025; this separated U.S. Postal Service employees, retirees, and dependents—previously comprising about 20% of FEHBP enrollment—into PSHB plans, requiring Medicare Part B enrollment for eligible annuitants to align costs and reduce federal subsidies, while maintaining OPM oversight and carrier competition for non-postal FEHBP continuity.[27][28] This reform addressed longstanding actuarial imbalances in postal retiree liabilities without altering core FEHBP operations for other agencies, underscoring the program's adaptability to fiscal pressures amid rising healthcare expenditures, with average premiums increasing 12.3% for 2026 plans.[29] Throughout the period, FEHBP's managed competition model sustained high satisfaction rates and plan innovation, with OPM negotiating rates to cap average employee premium shares at 25-30% of total costs.Program Administration and Eligibility
Oversight by the Office of Personnel Management
The Office of Personnel Management (OPM) administers the Federal Employees Health Benefits Program (FEHBP) under the authority of chapter 89 of title 5, United States Code, which establishes the framework for federal employee health insurance, and implements this through regulations in 5 CFR part 890.[30] OPM bears overall responsibility for program administration, encompassing the oversight of enrollment, premium processing, and benefit delivery for more than 8 million enrollees, including active employees, retirees, and eligible family members.[2] OPM contracts directly with over 200 health insurance carriers, approving or disapproving their participation based on criteria such as financial stability, management capability, and ability to provide efficient contract administration.[2][3] It conducts bilateral negotiations with carriers on proposed benefit changes and premium rates, with the process typically commencing approximately seven months prior to contract expiration and aiming to finalize agreements to align with the annual plan year starting January 1.[2] OPM approves final benefit brochures and rate schedules to ensure they meet statutory standards for comprehensive coverage while containing costs.[2] To maintain program integrity, OPM monitors carrier performance via audits of operations and financial data, evaluates overall program effectiveness through studies, and reports key findings to Congress, including trends in utilization, costs, and quality.[2] It enforces compliance with contractual obligations and federal laws by reviewing actuarial submissions, verifying accurate cost data, and imposing corrective actions for deficiencies, such as debarment for fraud or non-performance.[2][30] OPM also resolves disputes over denied claims or coverage between enrollees and carriers, providing an administrative review mechanism before potential judicial recourse.[2] OPM manages the Employees Health Benefits Fund, a centralized account handling government contributions, employee premiums, and carrier reimbursements, with oversight ensuring timely remittances from agencies and fiscal accountability.[2] It issues annual guidance, including the FEHB Program Carrier Letter, to direct carriers on policy updates, data reporting, and quality improvement initiatives, while coordinating with federal agencies on eligibility verification and enrollment support.[2] Through these functions, OPM balances carrier innovation with risk mitigation, such as contingency reserves held by plans to cover unexpected claims.[2]Eligibility Criteria for Employees, Retirees, and Families
Eligibility for the Federal Employees Health Benefits (FEHB) Program extends to most federal civilian employees appointed in the executive, legislative, or judicial branches, unless specifically excluded by law or regulation, with agencies responsible for determining individual eligibility.[31] Employees in temporary positions qualify if they are expected to work at least 130 hours per month or the equivalent for at least 90 days, receiving full government premium contributions if not covered under the Part-time Career Employment Act.[31] Other temporary or intermittent employees become eligible after one year of continuous service without breaks exceeding five days, though they must pay the full premium cost during that period.[31] Exclusions apply to certain categories, such as noncitizen employees stationed outside the United States, employees of the Tennessee Valley Authority, Farm Credit Administration-supervised corporations, and those hired on a contract, fee, or piecework basis without civil service status.[31] Retirees, classified as annuitants, may continue FEHB coverage if entitled to an immediate annuity under a civilian retirement system such as the Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS), and if they have been continuously enrolled in an FEHB plan—or covered as a family member—for either the five years immediately preceding retirement or their entire period of eligibility if shorter.[32] This five-year rule allows for brief interruptions if reenrollment occurs within 60 days of returning to federal service, and the Office of Personnel Management (OPM) may waive it in exceptional cases, such as disability retirement or involuntary separation.[32] Survivor annuitants qualify if the deceased employee was enrolled in Self Plus One or Self and Family coverage at the time of death and at least one eligible family member receives a survivor annuity.[32] Employees retiring under FERS Minimum Retirement Age plus 10 years of service also qualify provided the enrollment continuity requirement is met.[32] Eligible family members include the enrollee's legally married spouse and children under age 26, encompassing natural, adopted, stepchildren, and foster children, regardless of dependency, marital status, or student status.[33] Documentation such as birth certificates, adoption decrees, or court orders must be provided within 60 days of enrollment or a qualifying life event to verify eligibility.[33] Children aged 26 or older qualify as disabled family members if incapable of self-support due to a mental or physical disability that existed before age 26, supported by medical certification expected to persist for more than one year.[33] Ineligible relatives include grandchildren (unless legally foster children), parents, in-laws, and domestic partners without legal marriage; former spouses may access temporary continuation of coverage under separate provisions but not standard family enrollment.[33] Common-law spouses qualify only if recognized under state law, requiring proof of cohabitation, financial interdependence, and other evidence.[33]Enrollment Processes and Open Season
The Federal Employees Health Benefits (FEHB) Program permits enrollment and changes to coverage primarily during the annual Open Season, a designated period when eligible participants may select or modify plans without a qualifying life event. Open Season typically runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December, with changes taking effect on the first day of the first full pay period beginning in January of the following year.[34] [2] For the 2026 plan year, this period is scheduled from November 10 to December 8, 2025.[35] During this time, participants can enroll in a new plan, switch options (such as from Self Only to Self Plus One or Self and Family), change plan types, or cancel coverage entirely, provided they meet eligibility criteria.[36] [37] Outside of Open Season, initial enrollment is available to newly eligible federal employees within 60 days of their appointment or eligibility determination, allowing selection of Self Only, Self Plus One, or Self and Family coverage.[38] [39] Qualifying life events—such as marriage, birth or adoption of a child, divorce, loss of other coverage, or relocation—trigger a 60-day window for changes, including adding or removing family members or suspending coverage under specific conditions like temporary employment abroad.[40] Enrollment codes on Standard Form 2809 (SF 2809), the Health Benefits Election Form, designate coverage types: code 1 for Self Only, code 2 for Self and Family, and code 3 for waiver (opting out).[41] Failure to submit SF 2809 within the initial 60-day period for new employees results in automatic waiver of coverage, coded as ineligible unless later corrected.[39] Enrollment and changes are processed through agency human resources offices, the employing agency's payroll system, or electronically via the Employee Personal Page (EPP) on the Office of Personnel Management (OPM) website or BENEFEDS portal for dental and vision components integrated with FEHB decisions.[36] [42] Participants must verify family eligibility, as coverage extends to spouses and eligible children under age 26, or longer if disabled and unmarried, with documentation required for additions outside standard processes.[40] Automatic continuation of existing coverage occurs annually unless changes are made during Open Season, ensuring continuity but requiring active review of plan brochures for benefit updates and premium adjustments published by OPM.[43] Retirees and annuitants follow similar procedures but may face additional restrictions, such as post-retirement suspension options only under limited circumstances.[44]Plan Options and Coverage Features
Types of Health Plans Offered
The Federal Employees Health Benefits (FEHB) Program offers several types of health plans, primarily categorized as fee-for-service (FFS), health maintenance organizations (HMOs), and consumer-driven health plans (CDHPs), with variations such as preferred provider organizations (PPOs) and high-deductible options integrated into these structures.[45][46] These plans provide enrollees flexibility in choosing providers and cost-sharing arrangements, with over 180 options available nationwide as of 2025, including nationwide FFS plans accessible to all and local HMOs varying by region.[3] Fee-for-service (FFS) plans, including those with PPO networks, allow enrollees to seek care from any licensed provider without prior authorization, though using non-network providers may involve higher costs and reimbursement processes. In non-PPO FFS plans, the plan reimburses providers or enrollees directly after claims submission, often requiring paperwork and potentially leading to balance billing if provider charges exceed plan allowances. PPO variants within FFS reduce out-of-pocket expenses for in-network use, eliminating claims filing for network services while maintaining broader access outside the network at greater personal cost.[45] Health maintenance organizations (HMOs) emphasize coordinated care through a defined network of providers, typically requiring selection of a primary care physician (PCP) for referrals to specialists and limiting coverage to in-network services except in emergencies. Standard HMOs feature low copayments, no deductibles for in-network care, and minimal administrative burden, but out-of-network coverage is generally unavailable without reciprocity agreements between plans. HMO variants with point-of-service (POS) options permit out-of-network care at higher deductibles, coinsurance, and claims requirements, offering a hybrid between HMO structure and FFS flexibility.[45] Consumer-driven health plans (CDHPs) and high-deductible health plans (HDHPs) promote enrollee involvement in cost management by pairing high deductibles with personal health accounts, such as health reimbursement arrangements (HRAs) funded solely by the plan or health savings accounts (HSAs) allowing tax-advantaged enrollee contributions. These plans cover preventive services at low or no cost but impose significant deductibles—often starting above $1,500 for self-only coverage—before other benefits activate, alongside out-of-pocket maximums to cap catastrophic expenses; HSAs require HDHP enrollment and prohibit concurrent non-HDHP coverage like Medicare Part A.[45][47] CDHPs differ from traditional plans by encouraging price shopping and accumulating funds for future use, though they may deter utilization of non-essential services due to upfront costs.[48]Core Benefits and Coverage Standards
The Federal Employees Health Benefits (FEHB) Program requires all participating plans to offer a baseline set of comprehensive benefits, ensuring coverage for essential medical services without pre-existing condition exclusions or arbitrary limits on required benefits. These standards, established by the Office of Personnel Management (OPM) through regulations and annual carrier guidance, include inpatient and outpatient hospital care, surgical interventions, physician services, and emergency care, with plans prohibited from imposing lifetime or annual maximums on these core areas.[49][50] Prescription drug coverage is mandatory at a minimum level equivalent to Medicare Part D standards, featuring no lifetime or annual dollar maximums, deductibles not exceeding $600, and coinsurance capped at 50%, encompassing medically necessary drugs including insulin, off-label uses, and injectables without broad categorical exclusions.[50] Mental health and substance use disorder treatments must adhere to parity requirements, matching medical/surgical benefits in terms of deductibles, coinsurance, copayments, and visit/day limits, with adequate provider networks and out-of-network access at in-network rates when timely care is unavailable.[50][51] Additional required benefits encompass maternity care with minimum inpatient stays of 48 hours post-vaginal delivery or 96 hours post-cesarean (at patient option), infertility diagnosis and treatment including at least one form of artificial insemination, and non-experimental organ and tissue transplants such as bone marrow, cornea, kidney, liver, heart, lung, and pancreas, with donor costs covered.[49] Rehabilitative services, including physical, occupational, and speech therapies, must be provided for at least two months per condition, while preventive measures cover childhood and adult immunizations, well-child care, and allergy testing/treatment without limits tied solely to rehabilitation.[50] Recent OPM guidance has expanded standards to align with federal health mandates, requiring cost-sharing-free coverage for U.S. Preventive Services Task Force Grade A/B-recommended services (e.g., certain cancer screenings), Advisory Committee on Immunization Practices vaccines, and HIV pre-exposure prophylaxis including related monitoring; fertility preservation for iatrogenic infertility (e.g., gamete cryopreservation for at least one year); and obesity management via FDA-approved medications (at least one GLP-1 and two oral options) alongside intensive behavioral therapy programs.[51] Plans must also cover durable medical equipment such as glucose monitors and wheelchairs, home health services, and morbid obesity surgery, with brochures explicitly detailing compliance to facilitate enrollee comparison.[49] These uniform standards promote portability and adequacy across diverse plan types, including fee-for-service, HMOs, and high-deductible options, while allowing variation in premiums, networks, and supplemental features.[50]Coordination with Medicare and Other Programs
The Federal Employees Health Benefits (FEHB) Program coordinates with Medicare such that coverage priority depends on the enrollee's status and Medicare enrollment. For active federal employees under age 65 who become eligible for Medicare, FEHB remains the primary payer, with Medicare serving as secondary if the employee enrolls in Parts A and B.[52] In contrast, for federal annuitants (retirees) aged 65 or older enrolled in Medicare Parts A and B, Medicare acts as the primary payer, followed by FEHB as secondary, and then any other coverage like Medicaid as tertiary.[53] This coordination ensures FEHB fills gaps in Medicare coverage, such as deductibles, copayments, and coinsurance, without requiring separate claims filing in most cases, as Medicare electronically transfers claim data to the FEHB carrier.[53] Annuitants may suspend FEHB enrollment while covered under a Medicare Advantage plan or enrolling in Medicare Part D, preserving the right to reinstate FEHB upon resuming federal benefits, though failure to maintain Medicare eligibility can lead to loss of FEHB reinstatement rights.[54] Certain FEHB plans offer reimbursement for Medicare Part B premiums, typically up to 75% or full coverage depending on the plan, but this varies and is detailed in annual plan brochures; as of 2024, not all plans provide this benefit, and annuitants must weigh it against potential coordination advantages.[55] For prescription drugs, FEHB plans generally provide creditable coverage equivalent to or exceeding Medicare Part D standards, allowing enrollees to avoid Part D penalties if they later enroll, with FEHB coordinating to cover drugs not paid by Part D if both are active.[56] FEHB also coordinates with other federal health programs, prioritizing based on payer rules. With TRICARE (for uniformed services members and families), FEHB pays primary for active civilian federal employees eligible for both, while TRICARE serves as secondary; for annuitants, Medicare (if applicable) pays first, then FEHB, with TRICARE last unless suspended.[57] Similarly, for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), FEHB is primary for active employees, coordinating to cover eligible services after CHAMPVA payments, and plan brochures specify non-duplication of benefits.[58] Medicaid functions as a payer of last resort in these scenarios, covering remaining balances after FEHB and other primary coverages.[53] These rules, enforced by the Office of Personnel Management, prevent overpayment while maximizing coverage, though enrollees must verify specifics in their FEHB plan's annual materials to avoid out-of-pocket surprises.[3]Funding Mechanism and Costs
Government and Employee Premium Contributions
The government contribution to Federal Employees Health Benefits Program (FEHB) premiums is determined by a statutory formula under 5 U.S.C. § 8906, which limits the biweekly contribution to the lesser of 75 percent of the subscription charge for the selected plan or 72 percent of the weighted average subscription charges across all FEHB plans from the prior contract year, adjusted by a formula established in the Balanced Budget Act of 1997.[59][60] This "fair share" mechanism ensures the government covers a substantial portion—typically around 70-75 percent—of premiums program-wide, while employees or annuitants pay the remainder via payroll deductions or direct billing.[60] The Office of Personnel Management (OPM) calculates the weighted average annually by October 1, using enrollment data from March 31 and negotiated rates for continuing plans.[61] For full-time employees and eligible annuitants, the government share is funded from agency appropriations for active employees and OPM's appropriation for retirees, with no variation by plan type beyond the cap.[60] Employees pay biweekly amounts exceeding this contribution; for instance, in plans where the total premium surpasses the 72 percent average cap, the enrollee share increases accordingly.[60] Part-time career employees receive a prorated government contribution based on hours worked relative to full-time (e.g., 36/80 hours yields 45 percent of the full share), while temporary employees under 5 U.S.C. § 8906a pay the full premium without government subsidy.[60][61] Annuitants maintain the same contribution structure if enrolled in FEHB for the five years preceding retirement or since their first opportunity.[60] The maximum biweekly government contributions for 2025, reflecting 72 percent of the prior year's weighted average, are as follows:| Enrollment Type | Biweekly Government Contribution |
|---|---|
| Self Only | $286.09 |
| Self Plus One | $627.62 |
| Self and Family | $687.12 |
Historical and Recent Premium Trends
The Federal Employees Health Benefits (FEHB) Program's premiums have historically risen in tandem with broader healthcare cost inflation, reflecting factors such as medical advancements, provider reimbursements, and utilization patterns. From the program's inception in 1960 through the early 2010s, annual premium increases typically averaged 4-6 percent, aligning closely with private-sector employer-sponsored insurance trends as reported by actuarial analyses. Over the decade ending in 2022, the average annual FEHB premium increase was 3.64 percent, demonstrating relative stability prior to recent accelerations.[63] These trends were influenced by the program's competitive structure, where carriers negotiate rates annually under Office of Personnel Management (OPM) oversight, with government contributions limited to 72 percent of the program-wide weighted average premium or 75 percent of a specific plan's premium, whichever is lower.[60] In recent years, however, enrollee shares of premiums have experienced marked upward pressure, driven by post-pandemic surges in healthcare utilization, escalating prescription drug prices, rising provider costs, and heightened demand for behavioral health services. For the 2023 plan year, the average enrollee share increased by 8.7 percent; this rose to 7.7 percent in 2024 and peaked at 13.5 percent in 2025—the largest single-year hike in over a decade—before moderating slightly to 12.3 percent for 2026.[64][65][66] Overall program premiums increased by 10.2 percent in 2026, with the government share rising 9.2 percent on average, underscoring that enrollees absorbed a disproportionate portion due to the fixed contribution cap.[43] For context, the weighted average biweekly FEHB premium reached $694.83 in 2025, with government contributions capped accordingly.[67]| Plan Year | Average Enrollee Share Increase (%) | Key Notes |
|---|---|---|
| 2026 | 12.3 | Overall premium up 10.2%; post-2025 moderation but still elevated.[8] |
| 2025 | 13.5 | Largest in over a decade; driven by utilization rebound.[68] |
| 2024 | 7.7 | Continued rise from prior year.[69] |
| 2023 | 8.7 | Early signs of acceleration.[70] |
| 2022 | 3.8 | Pre-spike baseline.[68] |
| 2021 | ~3.6 (overall) | Stable amid pandemic.[63] |
| 2020 | 4.0 | Modest during initial COVID period.[71] |