What to expect for federal health care coverage next year – Federal News Network

Tom Taemin: It’s a strange time to talk about FEHBP as the open season is a few months off, but you’re a regular and I’m not that long so I wanted to do a final interview with you. And be sure to have a first clue as to what people are facing other than the rates rising on the next sign-up?

Kevin Moss: There are a few things we can talk about. First of all, we already know some of the priorities for next year’s OPM. They release these as career letters to let all FEHB carriers know that their new priorities will be next year’s planning year. And the big ones are administrative burdens. So this is how difficult it is to operate within a health insurance plan. They have three things they are looking for a career to improve next year. One is to submit an online claim. They want to fill out and submit fillable claim forms, submit support documents, and essentially allow you to manage your claim online.

Kevin Moss: An effective provider directory tool. Most carriers now offer these provider directory tools. But I think what OPM is doing here is a more pronounced indication of where this is. When you go to a career website, you don’t want to go hunting for five minutes to figure out where something is. So they want prominent links to appear on the carrier’s homepage, making sure that all provider directories have consistent information. Therefore, every provider directory requires the provider’s name, practice, or group name, network status, gender, expertise, whether the provider has board accreditation, language, new patient acceptance, telemedicine services.

Kevin Moss: And the final administrative burden is clear dispute claim information, ensuring that members understand how to file a dispute claim. We provide fact sheets, require deadlines, and if you and your health plan are not working, we will provide you with various ways to submit disputed claims and interact with the OPM. So I think these are all really welcome changes. Administrative burdens are like a really hot topic across health insurance, not just FEHB, and with advance approval, disputed claims, etc., OPM is trying to ease that administrative burden.

Tom Taemin: Yes, that’s interesting that they are looking to make the plans you have chosen easier to use. But is there anything about what health benefits are covered?

Kevin Moss: Yes, there are some extra little info. Therefore, HIV preparatory drugs should be covered as preventive care with a zero cost share. Health and maintenance organizations (HMOs) operating in service areas with power of attorney for in vitro fertilization (IVF) must provide the IVF benefits to cover its mission in the FEHB plan. What about mental health parity and network validity? This is a big problem. Provides access to mental health for all plan members. OPM looks at how difficult it is for new patients to get appointments, including member wait times and network utilization. And they said in some of these career letters that if it cannot happen within the network, careers may need to look for out-of-network benefits to ensure that those criteria are met from a mental health perspective.

Kevin Moss: You might want to talk about two more, one more. Therefore, organ tissue transplants – they are encouraging, but do not require carriers to provide compensation for transplant services recommended in clinical trials. And there were some executive orders that came from the Trump administration – it relates to gender-affirming care. The FEHB plan can no longer provide pediatric coverage of gender-affirming care. They also no longer require FEHB plans to cover gender-affirming care for over 19 individuals, but carriers have chosen whether they want to continue with those services, but no longer needed. Pediatric coverage for the 2026 plan – it is defined under the age of 19, but is no longer offered by the FEHB plan.

Tom Taemin: Okay, I think it’s really political – if you want to call it, is it a social, political, cultural hotspot that’s really in what they’re offering and what they’re planning?

Kevin Moss: Yes, I think so. And compared to the previous year, we haven’t actually seen it. Here, there is definitely something that will affect federal employees and pensioners. But I haven’t seen any major, big changes. Many of them are like administrative burdens, and how easy it is to run on a plan. I think it’s a big win for everyone. But I think we are mostly on the edge here in terms of new or expanded benefits.

Tom Taemin: I’m talking to Kevin Moss. He is a senior editor of the nonprofit consumer checkbook and an expert on the federal employee health benefits scheme. So we don’t know about the prices or anything like that. Inflation is a little lower than a year ago, but it’s coming during the open season. It’s all in the air, but another part of the world of OMB and OPM.

Kevin Moss: Yeah, but you’re sure you were listening – and your readers and listeners probably saw – a discussion about Capitol Hill about replacing premium government contributions with vouchers. And this is something that doesn’t have an official program, but it’s something that’s attracting a lot of attention. We have a bit of understanding how it works. To explain that, we need to explain how it works now. So how it works now is 72%, looking at all of the FEHB plans each year, getting the median premiums. That’s the amount of contribution. And it rises every year – not based on anything like CPI index. FEHB carriers will increase based on all premiums offered. What we’ve seen in recent years is that the increase in premiums is much higher than CPI. Tom, the average enrollment this year was 13%. And it was much higher than any CPI figure.

Kevin Moss: And the estimate is that if you access this voucher program, you could save between $1-2 billion, and the only way those savings can be achieved is whether subscribers pay more. And if this passes, yes, I think subscribers can expect to have to pay more share of the premium. At this point, it’s already happening with some very expensive plans in FEHB, where subscribers pay with some plans that are close to 37%-38% of premium instead of 25%. And what I’m hoping is that if this passes, there will be more plans. And I think I’ll shop your value and compare your choices – and we say this every year – you need to see what else there is there and assess the value of the options available. This will be even more important than if you accessed this voucher program. I haven’t passed yet. They’re still working on it on Capitol Hill, but this is something for everyone – it really has to be careful about this.

Tom Taemin: Wow, and it reinforces the idea that over the years, our most sought after, federal employee benefits issues are in the open season with FEHB. And I think that will likely be a future fact. Therefore, I would like to thank you for being such a stable voice for us over the past few years.

Kevin Moss: oh yeah. We love to do that and appreciate the commitment that the federal news network had to keep us informed of what is going on by maintaining our federal employees and pensions. That’s important. This is because OPM sometimes releases a lot of information. It’s technical information and not everyone follows what OPM is saying from a press release standpoint.

Kevin Moss: It’s enormous that people like Tom, Tom and Drew Friedman report on what’s going on with federal employees and pension candidates. We were able to do something like that Federal government with benefits I will continue this with a column that can be found monthly on the Federal News Network website. Maybe you’re not there, but it’s difficult to replace. You have been a truly important voice for federal employees and pensioners for many years.