FEHB Plan Comparison
Premium is only half the cost. Put two or three 2026 plans side by side on premium plus expected out-of-pocket, then read the break-even spend that tells you how far your year would have to go before the cheaper plan changes.
Reviewed by Jonathan D., 20-year federal employee · Formulas verified against OPM 2026 and 2027 premium rates ·
| What this models | Not modeled |
|---|---|
| Enrollee premium by tier for 10 nationwide-priced 2026 plans, from the OPM-verified repo dataset | Regional HMOs (Kaiser, UnitedHealthcare and similar). OPM prices those per state or region, so one number would be wrong |
| In-network deductible and catastrophic limit (out-of-pocket maximum) FOR THE TIER YOU PICK, read from each plan's own 2026 OPM brochure with the page and the sentence recorded; for the 2027 plan year, from OPM's 2027 plan-benefits file (posted September 29, 2026) with the worksheet row recorded | Out-of-network deductibles and limits. They are shown for reference where the brochure states them, and are never used in the math |
| Copay plans shown as a range: BCBS Basic Option has no calendar year deductible, so its total runs from its premium up to its premium plus its out-of-pocket maximum ($7,500 Self Only, $15,000 family, $7,500 for one person in its 2026 brochure; $8,500, $17,000 and $8,500 for 2027 in OPM's 2027 plan-benefits file). It is named the cheapest only when its maximum is below the total of every other plan at your spend, and no winner is named when its range overlaps another plan | Copays inside the cost math for any plan. The dataset has no per-service utilization, so the model uses charges and the deductible, not visit counts |
| Per-person limits inside Self Plus One and Self and Family: pick "mostly one person" and each plan's individual deductible and Self Only out-of-pocket maximum apply; the other answer is always reported too | Uneven splits in between (two people with large bills, say). Those land between the two answers the tool reports |
| APWU ($35) and MHBP ($52) required membership dues, shown on their own row and flagged when they could erase a margin | Dues inside the totals. They are billed by the union outside the premium, and the brochures allow exemptions by law |
| Primary care and specialist copays, shown for reference where the brochure sets a flat copay. FEP Blue Focus is shown as "$10, first 10 visits": its brochure charges $10 for each of the first 10 Preferred visits a year, then 30% after the deductible | A copay figure for the three plans whose brochures charge coinsurance for office visits instead (GEHA HDHP, Aetna HealthFund HDHP, Aetna Direct). Those fields are blank rather than guessed |
| Your coinsurance percentage as an explicit input, plus the 0 to 100 percent envelope | A real coinsurance rate. The 2026 dataset has no coinsurance field, so none is assumed for you |
| Plan-funded accounts, on their own line and inside every total, break-even band and envelope: the GEHA HDHP ($1,000 / $2,000 for 2026, $1,300 / $2,600 for 2027) and Aetna HealthFund HDHP ($66.67 / $133.34 a month for 2026, $800 / $1,600 a year for 2027) HSA deposits in full, or their HRA credit capped at your out-of-pocket if you cannot have an HSA; Aetna Direct's $900 / $1,800 Medical Fund paying your first charges before the deductible | Wellness-program rewards, HSA interest, your own HSA contributions, and money carried over from earlier years (unused HRA credit and Medical Fund roll over; this year's amount is all that is counted) |
| Active-employee enrollee share (5 U.S.C. 8906(b)) for 2026 or for 2027, the Open Season premium year, from OPM's 2027 premium charts | Annuitant monthly billing, FEHB and Medicare coordination, PSHB and TRICARE interactions. With the 2027 plan year selected, deductibles, out-of-pocket maximums, account amounts and office-visit copays come from OPM's 2027 plan-benefits file, but how a limit applies to one person inside a Self Plus One or Self and Family enrollment still follows each plan's 2026 brochure rule until the 2027 brochures post |
| Break-even spend scanned from $0 to $60,000 in $1 steps, reporting EVERY crossing in the band, not just the first | Crossovers above $60,000, and any crossover driven by services the model does not see |
| Precision: premiums to the cent, matching OPM's published enrollee-share column for all 30 plan-and-tier cells for 2026 and all 27 for 2027; totals rounded to the dollar for display | Prescription tiers, dental and vision (FEDVIP), FSA offsets, and taxes |
Why the cheapest premium is often not the cheapest plan
Two plans can differ by $1,400 a year in premium and still land within $50 of each other on total cost, because the plan with the lower premium carries the higher deductible and you pay that difference back the first time you use the plan. The only comparison that answers the question is premium plus out-of-pocket, computed at the amount of care you actually expect.
That is also why the break-even number matters more than the winner. If the crossover sits at $500 of charges, you are one urgent-care visit away from the other plan being the better pick, and the choice is close to a coin flip. If the crossover sits at $30,000, the decision is stable and you can stop thinking about it.
What the tool refuses to guess
FEHB plans pay a share of charges above the deductible, and that share varies by plan and by service. The 2026 dataset in this repo does not carry a coinsurance rate, so rather than quietly assume one, the tool takes your figure as an input and reports the whole band alongside it: the floor, where the plan covers everything past the deductible, and the ceiling, where nothing is covered until the catastrophic limit stops your spending. The band brackets what this model can produce on covered in-network charges at the deductible and catastrophic limit your tier carries. It is not a guarantee about your actual year. Fixed per-service copays, services the plan exempts from the deductible, prescription-drug maximums, out-of-network care and charges a plan excludes from catastrophic protection all sit outside it, and any of them can put a real bill above the ceiling. Your plan brochure is the authority.
One plan is left out of the cost-sharing math. BCBS Basic Option has no calendar year deductible at all — its 2026 brochure says so in those words — and shares cost through fixed copays instead. Running a deductible-and-coinsurance estimate on it would turn a $35 office visit into a percentage of the whole year's charges. But pricing it at premium alone would be worse, because Basic members do pay copays, up to a $7,500 Self Only out-of-pocket maximum in 2026 ($8,500 for 2027 in OPM's 2027 plan-benefits file, which also lists its deductible as “None”). So the tool shows Basic as a range, from its premium to its premium plus that maximum (never more than the charges themselves), and calls it the cheapest only when even the top of that range is below every other plan's total ("even at its out-of-pocket maximum, it costs at most…"). When its range overlaps another plan's total, the verdict says no winner can be named, and the break-even line says where the answer cannot be told.
Plan-funded accounts are counted, each the way its brochure describes it, because the three in this set work differently. For 2026 GEHA HDHP deposits $1,000 Self Only or $2,000 for the family tiers into your HSA, and Aetna HealthFund HDHP $66.67 or $133.34 a month; for 2027 OPM's plan-benefits file lists $1,300 / $2,600 and $800 / $1,600. That money is yours whatever you spend, so it comes off the total in full; on the default comparison it is what makes GEHA HDHP cheaper than GEHA Standard. If you cannot have an HSA, the same plans give an HRA credit instead, which only pays covered bills, so the tool counts it only up to your out-of-pocket. Aetna Direct's Medical Fund of $900 or $1,800 pays your first covered charges, and only then does the deductible start ($1,600 or $3,200 for 2026; $2,000 or $4,000 for 2027 in OPM's plan-benefits file); the fund counts toward neither the deductible nor the out-of-pocket maximum, so in a heavy year it saves nothing. Each account has its own line in the result, and the break-even line says which totals include one.
Where the premiums come from
Every biweekly premium in the 10-plan set was copied cell for cell from OPM's published 2026 rate files, and the government and enrollee split is computed with OPM's own rule: the government pays the lesser of 75 percent of the total premium or the program-wide contribution cap for the tier, with the 75 percent figure rounded to the cent, half up, in whole-cent arithmetic the way OPM prints it. All 30 enrollee shares in the set match OPM's published biweekly and monthly columns exactly. The figure the comparison uses is the enrollee share, which is what leaves your pay. APWU and MHBP also require union membership ($35 and $52 a year), billed separately; the comparison shows those dues on their own row rather than in the totals.
The deductibles and catastrophic limits come from somewhere else, and the distinction matters. OPM's premium workbooks carry no benefit figures at all, so every deductible, catastrophic limit and office-visit copay here was read out of the plan brochure itself — seven 2026 brochures covering the ten plans — for each of the three enrollment tiers separately, with the PDF page and the brochure's own sentence recorded next to the number. For the 2027 plan year the same figures for the nine plans still offered come from OPM's 2027 plan-benefits file, posted September 29, 2026, with the worksheet row recorded instead; only the per-person rule inside a family enrollment still follows the 2026 brochures, because that file has no column for it. None of the ten plans here charges the Self Only deductible as the family deductible, and for a high deductible plan it would not even be legal: IRS Rev. Proc. 2025-19 puts the 2026 floor at $1,700 for self-only coverage and $3,400 for family coverage. What the brochures do apply inside a family enrollment is a per-person cap: no one member pays more than the Self Only out-of-pocket maximum, and most plans give each member an individual deductible, which is what the “whose care is it” input models.
Regional HMOs are deliberately absent. OPM prices those per state or region, so representing one with a single nationwide number would be inaccurate on a money tool. For the single-plan view, including the monthly figures an annuitant sees, use the TRICARE vs FEHB comparison or the PSHB Part B calculator if you are postal.