Key Takeaways

Understanding PSHB Enrollment and What It Means for You

The Postal Service Health Benefits (PSHB) program is a major shift in how postal workers and retirees receive healthcare benefits. If you’re part of the USPS workforce or a retired postal employee, this transition is important for you and your family. With enrollment already underway, you may be wondering how to navigate your options and make the right choice for your healthcare needs. Let’s break it all down in a simple way so you can move forward with confidence.

1. Know Your Enrollment Periods and Deadlines

One of the most crucial things to keep in mind is when you need to enroll. Unlike regular insurance plans, PSHB has specific timelines that you must follow to ensure uninterrupted coverage. Here’s what you need to know:

  • Open Season: PSHB Open Season typically runs from mid-November to mid-December each year. This is your opportunity to make changes to your health plan, switch plans, or enroll if you haven’t already.

  • Automatic Enrollment: If you were previously covered under the Federal Employees Health Benefits (FEHB) program, you may have been automatically enrolled in a comparable PSHB plan. However, reviewing your options is still a good idea.

  • Special Enrollment Periods (SEPs): If you experience a Qualifying Life Event (QLE) such as marriage, divorce, birth of a child, or retirement, you can adjust your PSHB plan outside of Open Season.

Missing these deadlines could mean going without coverage or facing delays, so be proactive about keeping track of these dates.

2. Understanding How Medicare Fits In

If you’re a retired postal employee who is eligible for Medicare, PSHB requires that you enroll in Medicare Part B to maintain your PSHB coverage. This rule applies to many, but not all, retirees. Here’s what you need to know:

  • If you retired before January 1, 2025, you are not required to enroll in Medicare Part B, though it may still be beneficial.

  • If you retire on or after January 1, 2025, and are eligible for Medicare, you must enroll in Medicare Part B to keep your PSHB plan.

  • If you do not sign up for Medicare Part B when required, your PSHB plan may drop your coverage or significantly reduce its benefits.

The reason behind this integration is simple—Medicare helps cover certain medical costs, and PSHB plans work alongside it to minimize your out-of-pocket expenses.

3. Know Your Cost-Sharing Responsibilities

While PSHB offers extensive coverage, understanding your out-of-pocket costs is essential. Here’s a breakdown of the key expenses to consider:

  • Premiums: Your PSHB plan will have a monthly premium, which the government subsidizes at approximately 70%.

  • Deductibles: Most PSHB plans have a deductible, which is the amount you must pay before your plan starts covering costs.

  • Copayments and Coinsurance: Depending on the services you receive, you’ll either have a fixed copayment (like $30 per doctor visit) or coinsurance, where you pay a percentage of the total cost.

  • Out-of-Pocket Maximums: Each plan has a limit on how much you will spend annually on covered medical expenses. This is an important number to check when comparing options.

By carefully reviewing your plan’s cost structure, you can anticipate expenses and ensure that you choose a plan that fits your financial situation.

4. What Happens If You Do Nothing?

If you don’t take action during Open Season, several things could happen:

  • If you were previously enrolled in an FEHB plan, you’ll be automatically enrolled in a similar PSHB plan.

  • If you are a retiree and fail to enroll in Medicare Part B when required, your PSHB coverage may terminate or become more expensive.

  • If you are a new postal worker, you’ll need to enroll in a plan that meets your healthcare needs.

Simply assuming everything will be taken care of could result in unwanted surprises, so it’s always best to actively review your choices.

Making the Best Decision for Your Health and Budget

Now that you know the basics, how can you make the best choice? Here are a few things to keep in mind:

  • Compare plans carefully: Some plans may offer better benefits if you have Medicare, while others may be more beneficial if you don’t.

  • Think about your future healthcare needs: If you anticipate needing specific treatments or prescriptions, ensure your plan covers them affordably.

  • Don’t wait until the last minute: Reviewing your options early gives you time to ask questions and make informed decisions without feeling rushed.

Since health insurance is one of the most important benefits you have as a postal worker or retiree, taking the time to evaluate your choices can save you stress and money in the long run.

Get Personalized Help from a Licensed Agent

If you’re still unsure which PSHB plan is right for you, consider speaking with a licensed agent listed on this website. They can help answer your questions, explain cost-sharing structures, and guide you through the enrollment process.