Impact of Executive Orders on Federal Employees Health Benefits (FEHB) Coverage for the Coming Year
Federal employees and annuitants are advised to carefully review their options this fall when selecting an FEHB plan for 2026. The Office of Personnel Management (OPM) has released new guidance that will impact available benefits and plan function for the upcoming year.
The OPM's latest guidance emphasises the need for FEHB plans to deliver the best possible coverage at the lowest cost to plan members. In line with this, the OPM introduced a requirement for all carriers to offer a comprehensive obesity management program in plan year 2026. This program includes screening and support services, a specialized care team, patient monitoring, medication review, and more. However, following a decision by the Federal Joint Committee (G-BA), this program has been rescinded for the following year.
Federal employees who rely on gender dysphoria treatment services should also carefully review plan brochures this fall to determine which FEHB plans will continue to offer coverage and at what levels. Since January 2016, OPM has mandated that no FEHB carrier exclude services, drugs, or supplies related to gender dysphoria treatment. However, under the second executive order issued by President Trump, all FEHB carriers will exclude coverage for pediatric transgender surgeries or hormone treatments for the purpose of gender transition for dependents under the age of 19. Carriers may continue offering gender-affirming care services for individuals aged 19 and older but are not required to do so.
The OPM's latest guidance does not mention any changes to the gender policies or FEHB coverage for pediatric transgender surgeries or hormone treatments for the purpose of gender transition. Under the first executive order, all federal policies and documents will list only two genders, male and female, with no additional options or gender identity requests.
FEHB carriers are required to identify any resulting premium reductions and incorporate them into their benefit and rate proposals for plan year 2026. Carriers are also allowed to offer additional plan benefits for 2026, as long as they align with applicable laws and guidance.
Kevin Moss, a senior editor with the Guide to Health Plans for Federal Employees, advises those making decisions to carefully consider their needs and the options available. The Guide, provided by Consumers' Checkbook, offers free advice and may be available for free from your agency. You can purchase the Guide and save 20% with promo code GOVEXEC.
As federal employees and annuitants navigate the changes, it's essential to stay informed and make decisions that best suit their health needs and financial situation.
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