Fact check: Are federal employee health insurance benefits protected by law during a government shutdown?

1. Why FEHB survives a shutdown — the legal and operational backbone that protects coverage

FEHB continuation during an appropriations lapse rests on two pillars: statutory treatment of benefits and Office of Personnel Management (OPM) guidance. OPM has directed that FEHB transactions are excepted under the Antideficiency Act because processing enrollment and premium obligations are essential to avoid loss of benefits, so agencies must staff and process these transactions during a shutdown to maintain coverage. That guidance explicitly states FEHB coverage will continue even if an agency does not make premium payments on time, and agencies must generally ensure enrollees remain covered for the duration of the lapse ^[1]. This legal framework means coverage continuity is an active obligation, not a passive possibility, and it underpins how agencies, insurers, and providers must handle claims and member status throughout a lapse ^[4].

2. What happens to employee premium payments — accrual, withholding, and government contributions

During a shutdown employees placed in nonpay status typically continue to be enrolled in FEHB, but the mechanics of premium payment change: the employee’s share of premiums accrues during the nonpay period and is normally withheld from subsequent pay when the employee returns to pay status. OPM guidance and federal benefits advisories explain that the government contribution toward FEHB also continues while employees are in nonpay status, and agencies are expected to advance the employee share from salary where applicable — resulting in an accounting adjustment once pay resumes ^{[5] [2]}. Employees should expect unpaid premium balances to be recovered later, making short-term coverage continuity distinct from immediate cash-flow relief for enrollees.

3. How claims and provider interactions are managed — continuity amid administrative strain

Health plans and providers generally honor coverage and process claims according to normal plan terms during a shutdown, relying on OPM’s direction that FEHB enrollment remains active. Federal News Network and other benefit services reported that providers have processed claims and plan administrators continued routine activity because agencies except personnel to process enrollments and transactions ^{[4] [3]}. Practical disruptions can still occur, however, when agency payroll or benefits offices are understaffed or when specific carrier operations face delays; the legal protection of coverage does not eliminate temporary administrative backlogs or communication gaps between enrollees and carriers ^[1].

4. Changes to plans, discontinuations, and what employees should watch for

OPM guidance notes that coverage persists but does not guarantee every specific plan feature will be unaffected long term; plan discontinuations and network changes are separate processes governed by plan cy-pres rules and OPM’s contracting. Recent discussions about specific plan losses (for example, NALC FEHB plans) highlight that employees may need to evaluate alternatives such as consumer-directed health plans (CDHPs), high-deductible plans (HDHPs), or Medicare options, paying attention to provider participation and prescription coverage when selecting new plans ^[6]. Continuity in enrollment is not the same as immunity from plan shifts, so employees should proactively review plan notices and OPM communications to understand options and timelines.

5. Stakeholder perspectives and potential agendas shaping the messaging

Agency guidance and federal benefits advocates emphasize legal protections and continuity to reassure employees; unions and membership groups likewise highlight the obligation to maintain coverage and the accrual/withholding mechanics as protections against permanent loss of benefits ^{[7] [2]}. News outlets and benefits services frame operational realities — like backlog risks and plan-specific issues — which can emphasize different risks. These differing emphases reflect agendas: agencies and OPM seek to calm disruption fears and ensure compliance, unions focus on protecting member access and financial impacts, while independent benefits analysts stress practical service interruptions and plan-level consequences ^{[1] [6]}.

6. Practical takeaways for federal employees — what to do now to avoid surprises

Employees should verify current FEHB enrollment and read any plan or OPM notices, retain documentation of communications, and prepare for premium accrual during nonpay periods since withheld recovery will likely occur upon return to pay status. Contact plan carriers for confirmation that claims will be processed and keep providers informed about coverage status; if a plan is being discontinued, review alternative plan options promptly, paying close attention to provider networks and prescription formularies ^{[4] [6]}. The bottom line is simple and actionable: coverage is legally protected through a shutdown, but administrative and financial after-effects require proactive household budgeting and timely engagement with OPM and carriers to avoid unexpected gaps or costs ^{[5] [1]}.