OPM Calls for Shift to Wellness, Preventive Care; Seeks Expanded Access to Claims and Data
The Trump administration wants federal health insurance programs to focus on prevention and wellness in their plan offerings for 2027. It’s also incentivizing health insurance carriers to find “innovative” ways to cut costs while maintaining “comprehensive” coverage.
In its Plan Year 2027 Carrier Call Letter for the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs, the Office of Personnel Management (OPM) directed health insurance carriers to take an approach that prioritizes prevention, improves health outcomes, and supports long-term affordability.
The new focus comes after premiums spiked by an average of 12.3 percent for FEHB participants and 11.3 percent for PSHB participants in 2026.
“In plan year 2027, OPM is expanding its vision for benefits with a stronger emphasis on the physical and mental wellness of the whole person,” stated the letter. “This focus embraces individual autonomy, precision medicine and patient-centered care, and recognizes that the pursuit of mental and physical health should not be limited to the treatment of symptoms.”
Prevention and Wellness
Carriers are encouraged to expand access to non-pharmaceutical interventions and digital therapeutics, promote cost-effective sites of care, and reduce unnecessary or low-value services. For example, the letter calls for insurers to require other interventions before patients can pursue GLP-1 pharmaceuticals for obesity.
OPM also said it would emphasize informed decision-making regarding vaccines. FEHB will cover all “recommended” vaccines, but the agency said it would put renewed emphasis on ensuring participants are informed of vaccines’ potential risks.
OPM’s call letter comes several weeks later than usual. Carriers now have less than two months to align their benefits and adjust premium rates for the 2027 plan year.
Federal benefits experts say that while the letter likely won’t lead to a huge shift in coverage, its impact will be felt.
“There isn’t one thing that really stands out by itself as noteworthy, but combined the letter reflects a trend toward alternative treatments and expanding and encouraging the treatment of underlying causes rather than symptoms,” said National Active and Retired Federal Employees Association (NARFE) staff vice president for policy and programs John Hatton.
Health Records Access Debate
Meanwhile, OPM is reportedly seeking access to federal health claims data.
In a notice published in December, OPM wants to require insurers who work with FEHB and PSHB programs to provide monthly reports. Those reports would provide “service use and cost data” including “medical claims, pharmacy claims, encounter data, and provider data,” with no requirement that identifying information be removed.
OPM says providing the data will “ensure they provide competitive, quality, and affordable plans.”
Health and privacy experts who reviewed the proposal told KFF Health News that the proposal is vague and they are uncertain what exact data OPM is seeking.
But federal employee groups are lining up in opposition, particularly over the point of not redacting identifiable data.
“OPM has provided no meaningful explanation for why it needs identifiable data rather than the de-identified claims data that would serve any legitimate cost-management purpose. It has offered no information about how the data would be protected or how it would be used. That silence is not reassuring,” said the American Federation of Government Employees (AFGE).
