FEHB Premiums Jumping in 2026: The “Switch-or-Stay” Decision Framework

Most FEHB decisions don’t blow up because someone picked a “bad” plan.

They blow up because people don’t pick at all — and then the premium jump shows up like an uninvited guest.

If your premiums are rising faster than the rest of your retirement income, you need a repeatable way to make choices without turning Open Season into a second job.

Here’s the 5-step process.

The 5-step “Switch-or-Stay” process

1) Write your non-negotiables first

Before you look at any premiums, decide what you refuse to sacrifice:

• Must-keep doctors/hospitals

• Specific medications (especially specialty drugs)

• Travel/out-of-area coverage needs

• Ongoing therapy, durable medical equipment, or regular labs

This keeps you from “saving money” into a plan you’ll hate.

2) Capture your plan’s “Big 4” in 2 minutes

You’re collecting four numbers—nothing more:

• Premium (biweekly/monthly)

• Deductible

• Out-of-pocket max

• Your most common cost-sharing (primary care / specialist / urgent care + RX tier(s))

That’s enough to make a smart comparison.

3) Pick only two challengers

Don’t compare twelve plans. Compare two.

• Challenger A (Savings Plan): lower premium, similar style (HMO vs PPO)

• Challenger B (Protection Plan): higher premium, but stronger out-of-pocket cap / richer benefits

If your current plan can’t beat either challenger on “your” math, it’s on notice.

4) Run the “Breakeven Test”

Annual premium savings should be greater than the extra risk you take on.

A quick way to do it:

• Premium difference per pay period × number of pay periods

• Compare that to how much worse the deductible / copays / out-of-pocket max could realistically be for your usage.

Mini-example (illustration):

If a new plan saves $40 per pay period, that’s about $1,000/year.

If the deductible is $500 higher, you’d still likely come out ahead in a low- to medium-use year — unless your prescriptions or specialist visits get materially more expensive.

5) Make a decision that you can defend in one sentence

• Switch if you can say: “I’m buying the same access, for less money,” or “I’m paying a bit more to cap my downside.”

• Stay if you can say: “This plan is uniquely good for my doctors/meds, and the alternatives don’t pencil out.”

If you can’t explain it simply, you probably haven’t compared the right things yet.

When switching is worth it

Switching is usually worth the effort if any of these are true:

• Your premium increase is big enough that you feel it in your monthly cash flow.

• Your current plan’s premium is no longer “reasonable” relative to its deductible and out-of-pocket max.

• You’re paying for benefits you don’t use (common when life changes: kids aging out, fewer visits, fewer meds).

• You’re a high-utilization household and can lower your worst-case year by choosing a tighter out-of-pocket max.

• Your plan quietly drifted away from you: doctor network changed, RX coverage worsened, or referral rules got stricter.

When staying is the smart move

Staying can be the correct choice when:

• Your doctors/hospital system are hard to replace (and you actually use them).

• You have a medication situation where the current plan’s formulary is clearly better.

• You’re heading into a known high-spend year and you already understand how your plan behaves under stress.

• The “savings” option wins only if nothing goes wrong—meaning it’s not really savings, it’s a gamble.

Think of FEHB like portfolio construction: you want a core that works, and changes should be intentional, not reactive.

You’re not trying to find the perfect plan.

You’re trying to avoid the obviously wrong plan for your next 12 months.

Best,
—FWR