5 Open Season Questions and Answers

How much do you know about the process of making changes to your health insurance? Let’s look at a series of scenarios and see if you know the answers to the questions they pose.

After open season has ended and you are receiving your salary or retirement benefit that reflects 2020 health premiums, you notice a significant difference in the amount of your premium. You realize you are now in a new health plan because the plan you had in 2019 left the Federal Employees Heath Benefits Program or changed their service area--or your plan’s premium rates increased a lot more than the average increase reported during open season. You want to change plans. What can you do?

Unless you’re eligible for Medicare, you’ll have to stay with this plan until the next open season begins in November 2020 and then change to a new plan that will take effect in 2021. If you are eligible for Medicare, you can use OPM Form 2809 or SF 2809 any time beginning on the 30th day before becoming eligible to sign up.

You are retired and your spouse works in the private sector and received a notice that they are being laid off effective Dec. 31, 2019. They will be offered temporary continued coverage under COBRA, but may be required to pay the entire premium for coverage up to 102% of the cost to the plan. You’d rather switch your FEHBP coverage from self only to self plus one and cover your spouse. It is Nov. 29. What should you do?

It will still be open season, so you can choose to change from self only to self plus one coverage and it will take effect on Jan. 1, 2020. (If you’re currently employed, the new coverage will take effect during the first full pay period of the new year.) But under this scenario, the change also could be processed as a “qualifying life event.” That way, the change can take effect immediately.

You’re currently employed and have self plus one FEHBP coverage for you and your spouse. Your spouse, who is retired, will turn 65 in March 2020. What should you do between now and then?

There’s no need to change health plans, because your spouse can remain covered under your self plus one enrollment before and after turning 65. They should enroll in Part A of Medicare and not worry about Part B until the Medicare special enrollment period that will follow your retirement for eight months.

You have been covered under your spouse’s non-federal health plan until now because their employer covers the entire premium and offers very good insurance. You’re planning to retire when you reach your minimum retirement age, since you already have 30 years of service and are currently 49 years old. What should you do now, in preparation for your retirement at 57?

Nothing yet. You need five years of coverage under FEHBP in order to keep coverage in retirement. That means you can wait until the 2022 open season to get coverage that takes effect in January 2023. That way, you’ll have five years of coverage by January 2028 when you plan to retire that year.

Even if your spouse is planning to retire in 2020, or you’re worried that they might be laid off, you can still wait and change plans later if that happens under qualifying life event provisions. 

You’re in the process of getting a divorce. Your soon-to-be-former spouse, along with your two dependent children, are covered under your FEHBP self and family enrollment. What should you do when the divorce becomes final?

Your spouse is eligible for coverage while you’re in the process of getting divorced and even while you are legally separated. They lose eligibility for coverage as a family member when your divorce is final. You may continue self and family coverage for you and your dependent children. Your spouse can apply for FEHBP coverage under the “spouse equity” or “temporary continuation of coverage” provisions. 

It’s your responsibility to know when you or a family member is no longer eligible to use your health insurance coverage. Contact your FEHBP plan to notify them immediately of changes in family member status, including your marriage, divorce, annulment, or when your child reaches age 26.