Episode 97 – What you need to know about HCA open enrollment for 2027
Did you know you can change your health insurance plan during fall open enrollment? It’s a chance to review your coverage and see if your current plan is still right for you. Laura from the Health Care Authority joins us to explain what you need to know. Open enrollment is Oct. 26 – Nov. 23, 2026.
Episode transcript:
[music intro]
Jenny
Welcome back to Fund your Future with DRS. Well, since it’s officially fall, you might be thinking of all the regular fall things like pumpkin spice and football, but it’s also the time of year where public employees and retirees in Washington State can change their insurance plan during open enrollment. We usually do an annual podcast episode about open enrollment, so we thought it’d be a good time to revisit the topic with our friend Laura from the Washington State Health Care Authority to talk about the PEBB and SEBB programs. So welcome back, Laura. So, can you just kind of give us a brief overview of the PEBB and SEBB programs for those that don’t know.
Laura
Sure. So, first we have the SEBB program. So that is an acronym for School Employee Benefits Board. And this covers employees who work for K-12 school districts, charter schools and educational service districts.
And then we also have PEBB. So that acronym is the Public Employee Benefits Board. And this program covers employees of Washington state agencies, higher education institutions, and any participating Washington state employer group. And the PEBB program also includes retirees. So, when a person retires from either PEBB or SEBB employment once they enroll in our retiree health benefits, they are also part of the PEBB program.
Jenny
Thank you for that reminder.
Seth
We’ll try to distinguish when we’re just talking about things that have impact retirees and things that just impact our active employee group, but generally there’s some overlap. So, we’re going to try to cover everybody with this one episode. So Laura, as a person who is currently in one of the PEBB plans, when will I have my opportunity to change plans as part of open enrollment? When is the open enrollment period and when do those changes actually become effective for what my, coverage is?
Laura
So, open enrollment begins October 26th and it ends on November 23rd. And this is for employees and retirees. And then any changes that are made during this period of time go into effect January 1st of 2027.
Jenny
Excellent. Thank you for clarifying for the year there. And we know that the dates can change a little bit every year, but it’s generally around this October/November period.
Laura
Yeah. And kind of the rule of thumb with that is it’s always going to begin the Monday before Halloween or the last Monday of October and then end on the Monday before Thanksgiving.
Jenny
So obviously, this is a time where folks can change insurance plans. They can do a lot of compare and contrast between the plans. What are some things that I should consider if I’m thinking about changing my insurance plan? And maybe you could talk about some tools that might be available?
Laura
Sure. So, when a person is comparing plans, one of the things that it’s really important to look at is, what’s available where you live. So, you want to make sure that you choose a plan that works in your area. We have a great tool on our website.
It’s a plan comparison tool that kind of walks you through some basic questions like: where do you live? Are you an employee or retiree? If you are a retiree, are you eligible for Medicare? Some things like that. And then it will filter through the plans that match your criteria. And you can compare up to three plans side by side at a time.
If you’re, you know, looking to switch. And also something to consider if you are thinking about switching. Maybe you have a provider that you really love and you don’t want to lose access to that provider. You want to make sure that whatever plan you go into, is going to be considered in-network for your provider, so you can keep that person. And so, yeah, those are some things that I always tell people to kind of take a look at before they move around.
Seth
So, Laura, what sort of changes can a person make during open enrollment. So, I don’t know, maybe I got married. Maybe I have a child who’s aging out and no longer a dependent. What are the sort of things I have to make during open enrollment? And/or maybe then compare with some of the things that I could get a special change for not during open enrollment?
Laura
Sure is. Let’s just talk about the open enrollment changes first. So, this would be an opportunity for a person to change their medical, dental, or vision plan. You could add or remove, dependents during this time. A dependent might also include a spouse or state registered partner. You could waive medical coverage if you have some other type of access to employee group medical, coverage.
You could also pick up coverage. So perhaps you’re an employee who previously waived coverage. And this upcoming year in 2027, you want to reelect to join the program. You can also enroll or reenroll in a Flexible Spending Arrangement or an FSA, or a DCAP, a Dependent Care Assistance Program. So those might be some things that you elect to do in the new year.
And if you’re not eligible for Medicare, whether you’re a non-Medicare retiree or an employee, you might need to re-attest to, some surcharges. There’s a spousal surcharge if you’re covering someone who has access to other employer sponsored coverage. And there’s also a tobacco use surcharge. So, you may want to review those if you have any changes to your previous attestations.
Seth
Perfect.
Laura
And then some of these changes can be made under a special enrollment period. So, if you get married or you have a birth of a child, sometimes there’s changes you can make outside of open enrollment that may qualify for special enrollment. And then is there any sort of documentation that you have to present during, I guess, open enrollment or a special enrollment for those examples that you mentioned, like the birth of a child or if you have a spouse or domestic partner.
So, if you are adding somebody new that you haven’t previously covered, you may need to submit a birth certificate. Marriage certificate. It sort of depends on what type of change you’re making. But yes, there may be dependent verification documents that would be required and you would send those either with a paper form. Or you can also use the Benefits 24/7 online tool to make those changes as well. That same tool can be used for open enrollment changes.
Seth
And so, we’re talking now in 2026 about plans that’ll be available for 2027. But I know in the past some of the times we’ve talked, there have been changes to some of the plans, maybe changes in what plans are available, where, as you mentioned, some plans are only available in certain, counties or regions. Is there anything that either active employees or retirees should be aware of with things that are changing within the plans that could affect somebody’s decision during the open enrollment period?
Laura
Yes. So, unlike previous years, we don’t have any big major changes happening. But I’ll go through a few things that people may want to keep in mind. So really the main change is going to be the premium rates for 2027. So, whether you’re an employee or a retiree, you will want to make sure that you’re aware of premium changes.
Some of the plans aren’t changing very much with premiums and some are having somewhat of a significant increase. So, we want to make sure folks are aware, in the event, that you have maybe automatic deductions going out of your pension or certainly your paycheck as well, just so that you’re prepared for those and make sure that you have funds to cover those costs.
And then another thing to mention for retirees, if you’re on a Medicare plan that includes part D prescription coverage, CMS Medicare, they set the maximum out-of-pocket amount every year. And for 2027, they have raised that max out of pocket amount to $2400. So, something for retirees to be aware of. And then if you are in a consumer directed health plan or a CDHP, this would be for non-Medicare members.
The deductible is increasing to $1,750 for single subscribers and $3,500 for families. That’s also per IRS requirements. And another IRS requirement to mention is that the health savings accounts or HSAs for non-Medicare members, the annual maximum contribution is increasing to $4500 for single subscribers and $9000 for families. A few other things to be aware of. If you are someone in one of the Kaiser plans, there have been a few changes in regards to transportation services that are available.
So do, look into that if those are benefits that you are utilizing or want to utilize. They’re increasing the transportation services. We also have, this past year, Senate Bill 6183. And this requires all FDA approved antiviral drugs for the prevention and treatment of HIV without prior authorization or step therapy. So if there are therapeutic equivalent generic antiviral drugs available, the plans don’t need to cover the brand name and this is a change that would apply to all non-Medicare members.
So again, that’s in accordance with Senate Bill 6183. And then lastly the Uniform Medical plan. This one also is for non-Medicare members. There has been a program called the Centers of Excellence program which is for total joint replacement and spine surgery. That program is sunsetting at the end of this year, so it will no longer be available after December 31st of 2026.
So, anyone participating in that program, they need to have their surgeries completed by the time the program ends in order to qualify. And all this information and more is available on our website. And at the time of recording, we’re a couple of weeks out for getting the newsletters and other announcements mailed or emailed, but folks generally see those around mid-October.
Seth
And those mailings will include… I don’t want to bury the lead… because I think most times people are most interested in how it’s going to impact their paycheck. And so those mailings will include cost comparisons and show what the new premium amounts are going to be as well. Is that right?
Laura
Yes. It will include the new premium amounts and those are available already on our website. So, folks, have access to those premium amounts and those changes I kind of just went through. And then some more details are going to be coming throughout the month to make sure that everyone is aware and prepared going into open enrollment.
Seth
That’s great. You reminded me that one of our most common questions to DRS comes right at the end of January, when people get their January paycheck because their premiums have changed on their insurance, and they’re not quite sure why or why their benefit has changed that amount. So, it’s a good idea if you’re happy with your insurance and you’re not going to make any changes with your insurance premiums through the PEBB retiree program just to get a sense of how much is that dollar amount going to change.
Seth
So that actually leads into the next question I wanted to ask Laura. If a person doesn’t want to do anything, is there any action that needs to be taken from somebody each year during open enrollment?
Laura
Yes. Great question. Very popular question. Folks often ask, well, if I don’t want to do anything, do I have to do anything? And the answer is no. If you don’t want to make any changes to your current enrollments and you don’t tell us that you’re going to or intend to make any changes, then those carry over into the new year.
The only thing you might want to be aware of is those attestations for folks who are either employees or retirees, but not eligible for Medicare, you may need to check to see if there’s anything you need to re-attest to. Typically, it’s only if anything has changed from the last time you attested, but that’s really the only thing you need to check into. You do not need to tell us that you don’t want to change anything. It will automatically remain unchanged and carry over.
Seth
And when the rate changes happen, I mentioned already we usually see this on the end of January pension payment. Is that correct? That’s the first time a retiree will see this on their check?
Laura
Yes, January premiums would come out of their January pension. So, they wouldn’t see that till the new year.
Seth
Okay. And then for school employees that get paid at the end of every month, I’m assuming that’s also true. Their paycheck that they get at the end of January will be effective for this change.
Laura
Right. So, the paycheck won’t be affected for 2026 dates of work. It wouldn’t be until 2027 when the change goes into effect on the first.
Seth
Okay, great. I know we previously have recorded some episodes about some of the programs Laura mentioned, the flexible spending accounts and the DCAP program. Maybe we can make a link to that. I don’t remember the episode numbers off the top of my head. If people want to go do some more research about some of those other options that you can add on, or a great way to pay for some things with pretax money.
And maybe save yourself a little bit of money in your overall budget. Those are maybe underutilized programs for the benefit that they provide. And certainly worth, looking into. I’m assuming those programs exist both for the active PEBB employees and for the active SEBB, the school employees as well. Is that right?
Laura
I believe so, I am sorry I’m not as well versed in the active SEBB, but I am 99.9% sure that that would be the same. And I know Kimberly was on board for talking about some of those extra benefits that she manages for future. So obviously there is a lot of new things, kind of just depending on which insurance plan that you’re in, in which program that you may be considering.
Jenny
And you had mentioned that they will be sending out letters and emails with this information. And I’m assuming that those letters and emails will also have the information about, like in-person events that HCA offers.
Laura
Yeah. And that is another thing I wanted to mention is our open enrollment benefits fairs. So, these are great opportunities for employees and retirees to go to an in-person event so they can talk with not only us at HCA, but the health plans are all represented.
The dental, the vision plans DRS I know is always there as well. And those happen all across the state. So, we have fairs on both the east side of the mountains and the west side of the mountains. UW in Seattle also hosts four fairs that take place on different locations on their campus. And so, the dates, the times, the addresses and any additional details you might want to know.
Those will also be available on the website, but those are also going to be included in those newsletters that we send out to members. And so those will be available by mid-October. And then one other thing I’ll also mention is you have two different ways that you can make changes if you choose to do so. So, we have the forms that can be filled out and mailed or faxed.
And then we also have the Benefits 24/7 tool. And I would really encourage everyone to take advantage of the online tool. If they have the comfort and access to do so. This is a simple, quick way that you can make those changes. Whether you do this online or mail the form, they are due by November 23rd.
And that means if you send or fax a paper form, it has to be in our office by November 23rd. In the past, sometimes folks think, postmark date, but unfortunately, no, it has to be in office on November 23rd. So, if you’re able to do it online, that’s just one way you can avoid any uncertainty there.
Jenny
So again, just as a reminder that open enrollment period starts October 26th and goes through November 23rd this year for 2026. And all the paperwork must be received by that date.
Laura
Yes. And then, of course, we always have our office, visits available as well. So, if you’re near Olympia, you can come in to meet with somebody in our offices. And we will also have a virtual benefits fair. So, if you want to attend but you’re unable to attend in person, you’ll be able to go through a virtual benefits fair on our website. And of course, that would be available 24/7.
Jenny
Excellent. Well, Laura, I feel like we’ve definitely covered a lot about open enrollment. We know that folks will have more questions about this. We obviously, like you said, encourage them to reach out to you folks.
Laura
Yes, folks can certainly find us on our website. There’s also an option to send a secure email. And then, of course, call us by phone, which is 800-200-1004.
Jenny
Perfect. I’m glad that we got the phone number in there too. Well, thank you so much for coming on to the podcast today and for sharing about open enrollment. And we are so thankful that HCA is there as a great resource for folks to help with their health insurance coverage and with any questions that they might have.
Jenny
Absolutely.
Laura
Thanks so much for having me again.
[music outro]
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