{"id":364256,"date":"2025-11-08T09:58:14","date_gmt":"2025-11-08T09:58:14","guid":{"rendered":"https:\/\/www.europesays.com\/us\/364256\/"},"modified":"2025-11-08T09:58:14","modified_gmt":"2025-11-08T09:58:14","slug":"open-season-starts-monday-and-feds-face-rising-premiums-and-tough-choices-on-coverage","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/364256\/","title":{"rendered":"Open Season starts Monday and feds face rising premiums and tough choices on coverage"},"content":{"rendered":"<p><strong>Terry Gerton:<\/strong>\u00a0Open Season kicks off today. People might have been a little distracted by all the other things that are happening in the federal government and with the federal workforce, but if they wake up this morning and they\u2019re listening to us, they go, \u2018Oh my goodness, it\u2019s Open Season.\u2019 What should they know initially about timelines and important things to look at?<\/p>\n<p><strong>John Hatton:<\/strong> Well, they have from today until December 8th to make a choice of plans. And we highly encourage people to look at their plan options every single year. But really, this year, it\u2019s even more critical with the second year of double-digit premium increases. So you really have an opportunity to save money by choosing a different plan in many cases. There\u2019s a lot of good plan options with quality comprehensive coverage. And so it\u2019s really just about making sure you\u2019re able to walk through a process that makes you feel confident in that change of plans and choice. And so we\u2019re there to always help people with that decision-making process, but really encourage people to go through it.<\/p>\n<p>]]><\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0If people are furloughed and they\u2019re not seeing their office emails, they don\u2019t have access to their work computer, does that pose a challenge for anybody getting ready to enroll?<\/p>\n<p><strong>John Hatton:<\/strong>\u00a0People should still be able to enroll through the normal portals. I think where it poses a challenge with the shutdown ongoing is just communication from federal agencies. So OPM is still up and running. They have funds paid essentially through your premiums for administration of the program. But the agencies are shut down and you may not have health fairs going on. You may not have communication through agencies. You may be lost in terms of where to go to enroll and sign in. And so that part I think will be challenging for people, but accessing, being able to actually make a change and accessing OPM, hopefully should not.<\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0So they\u2019re going to have to do a little bit more of their own research at that point. Talk to us or point us in the right direction about what\u2019s new and what people should really be paying attention to in this year.<\/p>\n<p><strong>John Hatton:<\/strong>\u00a0Well, plan options remain pretty broad and comprehensive and there are tweaks from year to year. I think on the program-wide basis, there are some additional required coverages like PrEP medications for HIV treatment. The administration took away gender-affirming care treatments. There continues to be IVF coverage for infertility treatment in the program. So each plan has to cover at least one GLP-1 medication. So there are some tweaks around, I would say, the edges of the program in terms of program-wide, but I think people really need to take a look at their individual plan. And each plan may change, and I think we\u2019ve seen a little bit more changes, plan-to-plan, than we typically see or that we\u2019ve see in the past. I know on the postal side, there\u2019s some tweaks to Medicare reimbursements, which a lot of retirees find critical. So if you already have Medicare, you can get some money off those premiums in certain plans. There\u2019s been some tweaks on the Pulsar side, but not the federal side for that. So I think it\u2019s really important for people to look at that section two of the plan brochure and take a look at the individual changes because not only are you facing these increases in premiums, you may have changes in your underlying plan.<\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0So let\u2019s talk about those premium changes. This is a second year of double-digit premium hikes. What\u2019s driving the cost increases?<\/p>\n<p><strong>John Hatton:<\/strong>\u00a0I wish I could give you a very specific answer. OPM provided some very generic answers like costs of providers have gone up, some increased utilization of prescription drugs, including GLP-1s, is probably the most specific thing they provided. But the costs of health care are going up across the country and that\u2019s reflected in these premiums.<\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0Health care premium costs are a big issue in the shutdown conversation and negotiation. Is that related to the prices folks are seeing for the federal programs?<\/p>\n<p>]]><\/p>\n<p><strong>John Hatton:<\/strong>\u00a0Mostly no. The issue over the ACA premiums is whether to extend enhanced subsidies. So this is on the Affordable Care Act exchanges for people who don\u2019t have employer-based coverage, don\u2019t have Medicare, don\u2019t have Medicaid. And during COVID, one of the bills that passed enhanced those subsidies. So it used to be up to a certain amount. There are now stronger subsidies. So if those go away, people are seeing potentially triple-digit increases in their premiums in terms of percentage from just large amounts of money that are going to really make it hard for people to retain their health care coverage at all. And they don\u2019t have, I don\u2019t think, the same ability to choose a new plan that saves them more money the same way you may in response to the FEHB premium increases. There is still underlying increases in those premiums, though. So I think maybe 26% on the Affordable Care Act is changed if you take away the subsidies. So that is related. There\u2019s an underlying premium increase that\u2019s across the board that\u2019s affecting both FEHB and the Affordable Care Act, but the issue with the shutdown is these enhanced subsidies that allow people that don\u2019t have employer-sponsored coverage to get affordable health care. And that\u2019s kind of been the crux of the Affordable Care Act in the first place is providing some safety net and alternative outside of your employer-based coverage and luckily, federal employees and retirees have that employer-based coverage in its quality. But some people in this country don\u2019t.<\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0I\u2019m speaking with John Hatton. He\u2019s staff vice president of the National Association of Active and Retired Federal Employees. John, let\u2019s come back to the OPM plans. They made some changes to default plans for folks whose coverage is going away. What do people need to know if they\u2019re looking at an automatic enrollment? How is that process going to play out and what if it doesn\u2019t fit their needs?<\/p>\n<p><strong>John Hatton:<\/strong>\u00a0Yeah, anytime your plan is dropping out, you\u2019re defaulted into a different plan. So you don\u2019t totally lose coverage. You don\u2019t have to make an affirmative choice. That\u2019s a good positive thing. This year, the NALC plan is dropping out of the federal side of the program. They\u2019re still on the postal side. So if you\u2019re a postal employee or retiree, you can still retain it. But that\u2019s a significant number of people. OPM made the choice to not default into the lowest cost nationwide plan without a high deductible and without an association membership fee. That\u2019s what the regulation says. Then it has another sentence that says they reserved the right to designate an alternate plan for automatic enrollments. So this year, the lowest cost nationwide plan would be the GEHA Elevate plan, but instead, they have designated the GEHA High plan. So in the past, you would be automatically enrolled into a low-premium plan. In this case, you\u2019re automatically enrolled into a high-premium plan. So particularly if you had a consumer option in NALC, for example, you\u2019re going to see a huge spike in increases if you just defaulted in and you don\u2019t make an alternative choice. So we really encourage people to choose. I mean, maybe the high premium plan with more coverage is the right choice for you, but you may want to look at some other alternative plan, even with those low deductibles that might be cheaper because there are options, even with really low deductible plans that have lower premiums and kind of the main big dogs in the program. So really critical that you look and choose what\u2019s best for you.<\/p>\n<p><strong>Terry Gerton:<\/strong>\u00a0So back to our point at the beginning, which is people really need to do some research, especially if they don\u2019t have access to the experts in their organization.<\/p>\n<p><strong>John Hatton:<\/strong>\u00a0Yeah, and NARFE provides resources. We have webinars that walk people through their options and really step-by-step, how do you simplify the process? We actually surveyed members and first of all, about less than 5% of people change plans every year, unfortunately. And I think that\u2019s because they also said about 80% or more are content with their plan. But people are not content with these huge double-digit premium increases. But the reason they often, I think, don\u2019t change is because the complexity of the process and they\u2019ve said they\u2019d rather write at-will or read Shakespeare in terms of understanding the process. So we really try to simplify it step by step so you can feel confident that if you\u2019re making a choice that lowers your premiums, you\u2019re still retaining some quality coverage. And I think that\u2019s what people are most worried about. They have a plan that works for them. They don\u2019t like the premiums are going up, but for them to switch, they\u2019re taking a risk and a leap of faith that this other plan is going to do and meet their needs the same way. And I think when people realize that they could be leaving potentially thousands of dollars on the table, like that\u2019s the difference in premiums. It\u2019s for self-only plan for similar low deductible plans. It\u2019s $200 a month. For self and family, it\u2019s $500 a month. If you\u2019re switching to a high deductible plan, it\u2019s even more. So you could have $7,500 in premium difference in some cases from one plan to another. And yes, you\u2019re risking a higher deductible, but it\u2019s maybe $1500 more or something like that. So you\u2019re going to save $6,000 just on premiums and have to maybe pay a little more out of pocket after the fact. So just thinking about some of those things and what the trade-offs really are with some of these choices, it\u2019s a lot to navigate. It\u2019s complicated. People don\u2019t understand the terms all the time. They don\u2019t understand the tradeoffs and they want to make sure they can get health care when they need it. The plan is designed to utilize the fact that you have a choice in plans. It\u2019s a great competition to help drive down costs. And when people aren\u2019t actually making a choice, it\u2019s not really working that way. So I think we\u2019ve seen these double-digit increases in part because people aren\u2019t making those choices.<\/p>\n<p>Copyright<br \/>\n                            \u00a9\u00a02025 Federal News Network. All rights reserved. This website is not intended for users located within the European Economic Area.\n                    <\/p>\n","protected":false},"excerpt":{"rendered":"Terry Gerton:\u00a0Open Season kicks off today. People might have been a little distracted by all the other things&hellip;\n","protected":false},"author":3,"featured_media":364257,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,176415,1142,176416,176417,176418,176419,67,132,68],"class_list":{"0":"post-364256","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-health-care-premiums","11":"tag-healthcare","12":"tag-john-hatton","13":"tag-narfe","14":"tag-national-association-of-active-and-retired-federal-employees","15":"tag-open-season","16":"tag-united-states","17":"tag-unitedstates","18":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115513491784251390","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/364256","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=364256"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/364256\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/364257"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=364256"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=364256"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=364256"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}