Key Takeaways
- FEHB Self Plus One and Self and Family plans have distinct eligibility, enrollment, and premium structures for federal retirees.
- Consider your family size, anticipated health needs, and the official rules before selecting or changing FEHB coverage types in retirement.
Many federal retirees are surprised to learn that Self Plus One coverage isn’t always less expensive than Self and Family—especially as health needs and family situations change. Understanding the official rules, premium differences, and enrollment options helps you make informed decisions about your federal health benefits after retirement.
What Is FEHB Self Plus One?
Definition and eligibility requirements
Self Plus One is an enrollment type under the Federal Employees Health Benefits (FEHB) Program. This coverage option allows you, as a federal retiree, to insure yourself and one eligible family member. You can choose Self Plus One upon retirement or during open seasons, provided both you and your selected family member meet FEHB eligibility criteria.
You (the retiree or enrollee) must be enrolled in FEHB on the date of retirement to continue coverage. There are no minimum service requirements to enroll in Self Plus One, but the standard five-year coverage rule for continuing FEHB into retirement applies.
Covered family members
Under Self Plus One, you may cover one eligible family member. The eligible person must be a spouse or a recognized dependent child—including adopted children, stepchildren, and foster children—who meets OPM’s eligibility rules. You can only cover one family member per plan year, so it’s important to designate the individual you wish to insure alongside yourself.
Enrollment periods for retirees
FEHB Self Plus One enrollment for retirees generally follows the same rules as for employees. You may elect this coverage:
- During the annual Open Season (typically in November and December)
- In connection with a qualifying life event (QLE), such as marriage, divorce, or gaining a new dependent
- Upon initial retirement, provided you are eligible for FEHB continuation
How Does Self and Family Coverage Work?
Eligible dependents explained
Self and Family coverage under FEHB insures the retiree plus all eligible family members under a single policy. Eligible dependents may include your spouse and children up to age 26 (or older if disabled, per OPM guidelines). Foster children, if certified by the enrollee, are also recognized dependents, subject to the official eligibility rules.
Retirement enrollment rules
To keep Self and Family coverage in retirement, you need to meet the same basic FEHB continuation requirements—primarily, federal health benefits coverage for the five years prior to retirement or for all service since your earliest opportunity to enroll. You can select Self and Family during Open Season, after a qualifying life event, or at the point of retirement.
Coverage continuation options
If your family size or situation changes, you can switch between Self and Family and Self Plus One during designated times. Coverage may continue for your dependents as long as they meet OPM’s eligibility requirements. If a covered child ages out or a spouse’s status changes, you will need to re-evaluate your enrollment type.
What Are the Premium Differences?
How premiums are set by OPM
The Office of Personnel Management (OPM) establishes FEHB plan premiums annually based on the benefits offered, plan experience, and projected costs. The premium for each enrollment type—Self Only, Self Plus One, Self and Family—reflects the average expected claims for those groups, not the specific needs of any individual enrollee.
Comparing Self Plus One and Self and Family costs
FEHB Self Plus One and Self and Family premiums can be similar in certain plans and years. In some cases, Self and Family may cost only slightly more—or even less, depending on plan experience and OPM’s calculations. The actual dollar differences for retirees can be reviewed each year in OPM’s official FEHB premium tables.
Because these rates vary annually and by plan, it’s important to check the most current OPM materials rather than assume Self Plus One is always the lower-cost option if you have just two covered individuals.
Factors influencing premium changes
Plan premiums are influenced by several factors:
- Total claims from covered enrollees
- Projected medical cost inflation
- Changes in covered benefits or plan structures
- Distribution of family sizes within each enrollment group
External factors, like nationwide health care trends or government-wide benefit changes, can also affect premiums from year to year.
When Can Retirees Change Enrollment Type?
Open season opportunities
Federal retirees may change their FEHB enrollment type during the annual Open Season. This period typically runs from mid-November to mid-December. Any eligible retiree can move between Self Only, Self Plus One, and Self and Family options, even if their family status has not changed.
Qualifying life events
Outside of Open Season, retirees may change enrollment due to a qualifying life event (QLE), including:
- Marriage or divorce
- Birth or adoption of a child
- Loss of a family member’s eligibility (such as a child turning 26)
You generally have 60 days from the QLE to request a change in your FEHB coverage type.
Limitations after retirement
After retirement, you cannot newly enroll in FEHB if you weren’t covered as an employee and didn’t meet the five-year rule. Coverage type changes are allowed as described, but dropping coverage altogether is difficult to reverse.
Key Rules for FEHB in Retirement
Requirements for continuing FEHB
To carry FEHB into retirement, you must:
- Retire with an immediate annuity (not a deferred one)
- Be covered under FEHB for the five years prior to retirement or for your entire period of potential FEHB eligibility
Meeting these requirements preserves your right to change coverage types (but not carriers or plans outside normal periods) as a retiree.
Coordination with Medicare
Most federal retirees become eligible for Medicare at age 65. FEHB and Medicare can work together—Medicare becomes primary, and FEHB may pay second. Retirees can keep both; dropping FEHB is not required. The coordination rules between FEHB and Medicare may change out-of-pocket costs but do not affect FEHB premium structures.
Consequences of dropping coverage
If you cancel FEHB in retirement, you generally cannot reenroll unless you lose other coverage that makes you eligible for a Special Enrollment Period. Suspension is allowed only for certain alternative coverages (such as TRICARE), but cancellation is usually permanent for retirees.
What Should I Consider Before Choosing?
Family size and member eligibility
Consider the number of eligible family members who may need coverage. If you have more than one eligible dependent, Self and Family may be the more suitable choice. If you have only a spouse or one child to cover, Self Plus One may be appropriate, but always compare premiums and eligibility carefully.
Future health care needs
While future health expenses are unpredictable, think about:
- The likelihood of adding dependents (e.g., a new grandchild under guardianship)
- The prospect of dependents aging out or no longer being eligible
- Evolving healthcare needs as you and your dependents age
Cost vs. coverage trade-offs
Compare annual premiums, out-of-pocket costs, and potential for adding/removing dependents. Review each plan’s benefits and premium tables published by OPM, and remember that lower premiums may not always lead to lower total healthcare costs if coverage is less comprehensive for your household situation.
