“They have three things that they’re looking for carriers to improve on next year. One is online claims filing,” said Kevin Moss.
An old bit of wisdom says the average person has lots of problems, but when you have a serious health issue, you’ve got just one problem. That’s why the Federal Employee Health Benefits Plan program is so important to federal employees at all levels. For several years, my next guest has been a walking encyclopedia of facts about the FEHBP. Here on the Federal Drive with Tom Temin with a review and a very early look at what might be in store for next year, the senior editor of Consumers’ Checkbook, Kevin Moss.
Interview transcript:
Tom Temin: It’s an odd time to be talking about FEHBP since open season is months off, but since you’ve been a regular, and I won’t be very long, I wanted to get one last interview in with you. And is there any initial clue as to what people might be facing besides rate increases in the coming next round of signups?
Learn how FEMA and DoD teams are using collaboration, automation and AI to shape cybersecurity at the edge in our new Executive Briefing, sponsored by Verizon. Download today!
Kevin Moss: There’s a couple of things that we can talk about. First of all, we already know some of OPM’s priorities for next year. They release these as carrier letters to inform all the FEHB carriers of what their new priorities are going to be for the next plan year. And so a big one is administrative burden. So this is just how difficult it is to operate within a health insurance plan. They have three things that they’re looking for carriers to improve on next year. One is online claims filing. They want you to be able to complete and submit fillable claim forms, be able submit supporting documents, and basically being able to manage your claims online, trying to cut away some of the older ways of doing this like faxing and mailing things.
Kevin Moss: Effective provider directory tools. Now most carriers are providing these provider directory tools. But I think what OPM is going for here is more prominent display of where this is — like when you go to a carrier website, you don’t want to hunt around for five minutes to figure out where something is. So they’re asking for a prominent link displayed on the carrier homepage and making sure that there’s consistent information across all the provider directories. So every provider directory has to have the provider name, practice or group name, location, network status, sex, specialty, whether the provider has a board certification, languages spoken, accepting new patients and telemedicine services.
Kevin Moss: And then the final administrative burden piece is clear disputed claims information, allowing members to understand how to file a disputed claim. Providing fact sheets, required deadlines, and also offering a variety of ways to file a disputed claim and to interact with OPM if something’s not going well with you and your health plan. So I think these are all real welcome changes. Administrative burden is like a really hot topic, not just in FEHB, but across health insurance — things like prior authorization, disputed claims — and OPM is trying to ease that administrative burden.
Tom Temin: Yeah, that’s interesting that they’re looking on making it easier to use the plan that you choose, I guess. Nothing about what health benefits are covered specifically, though?
Kevin Moss: Yeah, we’ve got a few additional little tidbits. So one is also HIV PrEP medications now must be covered as preventative care at zero cost share. Any Health Maintenance Organization (HMO) that operate in service areas that have a state in vitro fertilization (IVF) mandate must provide IVF benefits to cover that mandate in their FEHB plan. How about mental health parity and network adequacy? This is a big issue. Making sure that all plan members have access to mental health. OPM’s looking at things like member wait times and network utilization rates and how hard it is for new patients to get appointments. And they have said in some of these carrier letters that if that can’t happen in-network, then carriers may need to look for out-of-network benefits to make sure that those standards are being met in terms of mental health parity.
Kevin Moss: Two more, and one I might want to talk just a little bit more about. So organ tissue transplants — they’re encouraging, but not mandating that carriers provide coverage for transplant services that are recommended under clinical trials. And there was one related to some executive orders that have come from the Trump administration — it has to do with gender-affirming care. FEHB plans no longer can provide pediatric coverage of gender-affirming care. They are also no longer requiring FEHB plans to cover gender-affirming care for individuals 19 or above, but carriers do have the choice as to whether they want to continue providing those services, but they’re no longer required. Pediatric coverage for plan year 2026 — that’s defined by younger than 19 — is no longer provided by any FEHB plan.
Tom Temin: All right, so that’s the only really, I guess, political — if you want to call it that — social, political, cultural hotspot really that’s in what they’re offering or what they are planning for?
Sign up for our daily newsletter so you never miss a beat on all things federal
Kevin Moss: Yeah, I think that’s right. And compared to previous years, we’re not really seeing —there’s some things that will definitely have an impact for federal employees and annuitants here. But I’m not seeing, like, huge, big changes. A lot of it is kind of the administrative burden, which is how easy it is to operate in plans, I think is a big win for everyone. But in terms of new benefits or expanded benefits, I think we’re mostly on the edges here.
Tom Temin: We’re speaking with Kevin Moss. He’s senior editor for the nonprofit Consumers’ Checkbook and an expert on federal employee health benefit plans. So then we don’t know rates or anything. That comes at the open season time, although inflation is a little lower than it was a year prior, and we don’t know what they might plan for employee contribution to all of this. That is all up in the air, but another part of the world for OMB and OPM.
Kevin Moss: Yeah, but I’m sure that you’ve been hearing — and your readers and listeners have probably been seeing — the discussions on Capitol Hill about replacing the government contribution of premium with a voucher. And this is something that has gotten a lot of attention, although we don’t have an official program. We kind of understand a little bit of how it might work. In order to explain that, we have to explain how it works right now. So how it works right now is every year, OPM looks at all of the FEHB plans and they get a median premium and it’s 72%. That’s the amount of the contribution. And it goes up every year — not based upon things like the CPI index. It goes up based upon all of the premiums that are being offered by the FEHB carriers. What we’ve seen in recent years is that the increase in premium is much, much higher than CPI. Tom, this year, the average enrollee premium was 13%. And that was much higher than any of the CPI figures.
Kevin Moss: And the estimates are somewhere that if they go to this voucher program, it could be $1 to $2 billion of savings, and the only way those savings are realized is if enrollees are going to be paying more. And I think we can expect, if this were to pass, that yes, enrollees will have to pay more share of the premium. Right now that’s already happening in some really more expensive plans in FEHB where enrollees are paying, in some plans, close to like 37%–38% of the premium, not the 25%. And what I expect is that if this were to pass, there’s going to be more plans — I think more plans where the enrollee is going to be paying more. And I think shopping for value and comparing your choices — and we say this every year, Tom — you’ve got to look at what else is out there and assess the value of the options that are available to you. This is going to be even more important than it’s ever been if we go to this voucher program. It hasn’t been passed yet. They’re still working on it on Capitol Hill, but this is something for everyone — that’s really going to have to pay attention to this one.
Tom Temin: Wow, and so that reinforces the idea that over the years, some of our most sought after and followed coverage for federal employees and federal employee benefit issues is at FEHB and the open season. And I think that’s probably going to be the case ahead. And therefore, I want to thank you for being such a steady voice for us these past several years.
Kevin Moss: Oh yeah. We love to do it and we appreciate the commitment that Federal News Network has had with keeping federal employees and annuitants informed about what’s going on. It’s important because, you know, sometimes OPM is putting out a lot of information. It’s technical information, and not everyone’s following what OPM is saying in terms of their press releases.
Kevin Moss: So having you, Tom, folks like Drew Friedman reporting on the ground of what’s happening with federal employees and annuitants has been huge. We’ve been able to do things like the Feds With Benefits column that you can find monthly on the Federal News Network website, and we’re going to continue to do this — maybe even without you, Tom, although you’ll be a hard one to replace. You’ve been a really important voice for federal employees and annuitants for many years.
Read more: Benefits
Copyright © 2025 Federal News Network. All rights reserved. This website is not intended for users located within the European Economic Area.
Tom Temin is host of the Federal Drive and has been providing insight on federal technology and management issues for more than 30 years.
Follow @tteminWFED