Some FEHB Plans Charge More for Self Plus One Than for Family Coverage

Federal employees sometimes pay more to cover themselves and one family member than they would for an entire family under the same health plan. In 2027, several FEHB options have this pricing quirk, with the difference reaching $76.29 per biweekly pay period.

These figures represent biweekly enrollee premiums for 2027 non-postal coverage. They are examples rather than a complete list of affected plans. Employees can review all options in OPM’s 2027 premium charts. Annual differences are calculated using 26 pay periods. Postal employees covered by the Postal Service Health Benefits Program have different rates.

How Family Coverage Can Cost Less

The unusual pricing doesn’t mean the plan charges more in total for Self Plus One coverage. In fact, the total premium for Self Plus One is never higher than the total premium for Self and Family. The difference comes down to how much the government contributes toward each enrollment type.

Under federal law, the government’s contribution is generally the lesser of a maximum amount or 75% of the plan’s total premium. Those maximum contributions are calculated separately for each coverage category.

For 2027, the maximum government contribution is $767.53 per pay period for Self Plus One and $843.82 for Self and Family. That $76.29 difference can affect what employees pay out of pocket.

Kaiser Northern California High illustrates how this works. The plan charges the same total premium, $1,335.54, for both enrollment types. However, because the government contribution is higher for Self and Family coverage, employees pay $491.72 for that option compared with $568.01 for Self Plus One.

An Exception, Not the Rule

This pricing arrangement affects a relatively small share of FEHB enrollees. According to OPM, Self Plus One coverage costs less than Self and Family for 95% of enrollees.

When OPM introduced the Self Plus One enrollment category in 2016, it required plans to keep the total premium at or below the Self and Family rate. However, the agency also recognized that differences in government contributions could still leave some employees paying more for Self Plus One.

What Employees Should Compare During Open Season

Employees covering just one family member shouldn’t automatically assume Self Plus One is the less expensive choice. It’s worth checking both enrollment rates in the plan’s premium chart. If Self and Family coverage costs less, employees can contact their agency’s HR office or the plan to confirm their enrollment options.

Premiums are only one part of the comparison. Deductibles, copayments, coinsurance, and out-of-pocket maximums can also affect the overall cost of coverage.

The 2027 FEHB Open Season runs from November 9 through December 14. Comparing both coverage categories before making an enrollment decision could help some employees avoid paying more than necessary.