2027 FEHB and PSHB: Review Your Coverage Changes
The next health-plan decision involves more than a higher premium. OPM's guidance for the 2027 FEHB and PSHB plan year addresses prescriptions, preventive care, and how services are delivered. Your household's experience will depend on the plan you choose and the care you use.
Open Season runs from November 9 through December 14, 2026. Before making an election, review the new plan materials alongside your prescriptions, providers, and retirement budget. This follow-up to our 2027 premium planning guide focuses on the coverage questions worth asking.
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Read the premium figures as averages
OPM reports a 10.9 percent average increase in the FEHB enrollee share for 2027 and an 8.2 percent average increase for PSHB enrollees. The corresponding total-premium increases are 9.3 percent and 6.7 percent. The enrollee share and the total premium measure different things.
Your plan's actual change may be higher or lower. Compare the same option, enrollment code, and payment frequency in both years. Use the dollar amount deducted from your pay or annuity rather than applying the program average to your current premium.
For example, a hypothetical $40 monthly increase adds $480 to annual premiums. That calculation does not include deductibles, prescriptions, or other cost sharing. A complete comparison should include those expenses as well.
Check prescription coverage and treatment requirements together
OPM continues to require at least one GLP-1 anti-obesity medication and at least two oral anti-obesity medications on carrier formularies. That does not mean every drug, indication, or prescription is automatically covered.
The 2027 guidance connects anti-obesity medication coverage with documented participation in evidence-based intensive behavioral therapy before and during treatment. Review your plan's authorization and documentation rules with the carrier and treating clinician, particularly if you already receive treatment.
Ask which medication and dosage are covered, whether your pharmacy participates, what you will pay, and how an existing authorization carries into the new year. Keep written answers or reference numbers. Do not interpret a general formulary requirement as approval of an individual claim.
Review preventive care without assuming all services are identical
OPM's vaccination guidance continues coverage of recommended vaccinations while addressing informed consent and provider-based incentives. Confirm the plan's in-network arrangements and the rules for the service you expect to receive. Coverage guidance is not a substitute for a medical discussion with your clinician.
The 2027 technical guidance also calls for coverage without cost sharing for USPSTF-recommended perinatal depression preventive interventions. Eligibility, the specific service, and provider participation still need to be checked. This should not be read as a promise that every mental-health service is free.
For planned care, ask the provider and carrier to identify the benefit category before the appointment. A preventive intervention, diagnostic visit, and ongoing treatment can have different billing and coverage rules.
Look beyond the name of a wellness benefit
OPM's coverage explanation describes participatory wellness incentives and plan-dependent digital therapeutics. A digital therapeutic is not simply any health app, and availability can vary by plan.
Review eligibility, covered programs, approved providers or vendors, and any conditions on rewards. Do not assume a cash-equivalent incentive can be spent without restrictions or that every program advertised as wellness has the same tax treatment.
Also check where a service is covered. Site-of-care policies may favor an appropriate outpatient, office, or other setting. Before arranging a procedure or infusion, ask whether the location affects authorization, network treatment, or your share of the bill.
Read a termination notice before relying on renewal
Most continuing health-plan enrollments do not require an annual change merely to stay enrolled. A terminating option is an important exception.
OPM identifies UnitedHealthcare Insurance Company, Inc.'s Choice Plus Primary Postal East PSHB plan as unavailable for 2027. Its notice says affected enrollees should choose another plan during Open Season; otherwise they will be enrolled in the designated default, FEP Blue Focus. This is a specific plan termination, not a statement that all UnitedHealthcare plans are ending.
Match any notice to your own enrollment code and service area. Even when a default prevents a coverage gap, its network, prescriptions, and costs may differ from your current option. Review those details before letting the deadline pass.
Include the retirement treatment of premiums in your budget
Eligible employees participating in FEHB premium conversion generally pay their share with pretax salary. Annuitants whose premiums are deducted from their retirement benefit do not participate in that premium-conversion arrangement. Reemployment can introduce different rules.
This difference can affect spendable income, but it is not a new percentage surcharge imposed on the premium. The tax effect depends on your circumstances. Compare projected net retirement income and actual insurance deductions, and ask an appropriate tax professional about your situation.
Include other applicable coverage costs, such as dental, vision, and Medicare premiums. Do not assume a lower health-plan premium preserves the same doctors or prescription coverage. Check those needs directly before switching.
Make a short list before Open Season begins
Use a single checklist for each plan you are seriously considering:
- Exact 2027 premium for your enrollment type and payment frequency.
- Provider and hospital participation, including planned treatment locations.
- Prescription coverage, authorization requirements, and pharmacy costs.
- Deductibles, copayments, coinsurance, and applicable out-of-pocket limits.
- Any termination notice or action you must complete before December 14.
OPM expects full plan brochures and comparison information in early November. Use those plan-specific materials to finish the review, and keep confirmation of any election you submit.
Internal Benefit Advisors helps federal employees review retirement eligibility, benefit estimates, and insurance decisions. Bring your plan materials, current deductions, and household budget to a retirement benefit review to consider how health costs fit into your retirement income.
Book a no-cost review to organize your Open Season questions before making your decision.