You’re Being Sold on Medicare Advantage—But Here’s What You Might Not Be Told

Key Takeaways

• While Medicare Advantage plans might look attractive in marketing materials, many hidden tradeoffs affect your access, costs, and coverage in 2025—especially if you’re a Postal Service annuitant enrolled in PSHB.

• Understanding how Medicare Advantage interacts with your PSHB plan, including requirements, limitations, and cost-sharing, is critical before making any switch.

What Looks Great in Ads May Not Tell the Whole Story

You have probably seen the TV commercials or received glossy brochures in the mail, all touting how Medicare Advantage offers “comprehensive coverage,” extra perks, and lower costs. But for 2025, especially under the new Postal Service Health Benefits (PSHB) program, these plans often come with conditions you won’t see in the fine print.

Medicare Advantage, also known as Medicare Part C, is offered by private companies approved by Medicare. These plans combine Parts A and B, and often include drug coverage (Part D) and other benefits like dental and vision. However, they operate quite differently than traditional Medicare or PSHB plans.

If you’re a Postal Service retiree or annuitant, this matters more than ever. With the mandatory transition to PSHB in 2025, understanding the nuances between Medicare Advantage and traditional Medicare paired with a PSHB plan could impact your access to care and out-of-pocket costs.

The 2025 PSHB Landscape and Your Options

As of January 1, 2025, all Postal Service retirees and employees are moved under the new PSHB system. The PSHB program is tailored for Postal employees but still parallels the structure of FEHB. For Medicare-eligible retirees, you are required to enroll in Medicare Part B unless you meet a specific exemption.

What changes in 2025:

• If you’re Medicare-eligible, you’re expected to enroll in both Part A and Part B to keep your PSHB coverage.

• Prescription coverage is integrated with Medicare Part D through an EGWP (Employer Group Waiver Plan).

• Some PSHB plans offer Medicare Advantage options, but these are not the default.

While PSHB plans may offer incentives for enrolling in Medicare Advantage versions, such as reduced cost-sharing or Part B premium assistance, these perks come with tradeoffs.

What You Might Not Hear About Network Restrictions

Traditional Medicare with a PSHB plan allows you to see almost any doctor or specialist who accepts Medicare across the country. There are no network limitations. But Medicare Advantage plans use managed care networks, typically HMOs or PPOs.

That means:

• You may need referrals for specialists.

• You might be limited to local or regional provider networks.

• If you travel or live in multiple states throughout the year, you could face issues accessing care.

In 2025, some Medicare Advantage plans have expanded their networks slightly, but not nearly to the level of traditional Medicare. This can be a major concern for Postal retirees who split their time between different states.

Prior Authorization: A Barrier to Timely Care

One of the most controversial aspects of Medicare Advantage is prior authorization. Unlike traditional Medicare, where medically necessary services are typically covered without delay, Medicare Advantage often requires your provider to get approval before you receive certain services.

This includes:

• Advanced imaging (MRIs, CT scans)

• Inpatient hospital care

• Some surgeries

• Home health services

In 2025, the Centers for Medicare & Medicaid Services (CMS) has introduced new rules requiring plans to speed up the prior authorization process, but delays and denials still happen.

As a PSHB enrollee, your traditional Medicare and PSHB plan combination may give you more direct access to care without hurdles that slow down treatment.

You May Pay More Out-of-Pocket Than You Think

Medicare Advantage plans often market their caps on annual out-of-pocket costs, which in 2025 are $9,350 for in-network and $14,000 combined in- and out-of-network. But those figures don’t tell the whole story.

Many PSHB plans that coordinate with traditional Medicare offer:

• Lower coinsurance when you have Part B.

• Waived or reduced deductibles.

• Cost-sharing benefits that kick in automatically.

But with Medicare Advantage:

• You may still have copays for nearly every service, including hospital stays, specialists, and diagnostics.

• Out-of-network care may not be covered at all or come with steep costs.

• Drug coverage is bundled, limiting your ability to shop around for a separate Part D plan with better pricing.

It’s a false sense of security to rely on maximum limits that you might reach only after thousands of dollars in incremental spending.

Coverage Can Change Annually

Another downside of Medicare Advantage is that the plan you enroll in during Open Season may not look the same next year. Each fall, you receive an Annual Notice of Change (ANOC), and it’s important to read this carefully.

Plans can change:

• Premiums

• Deductibles

• Drug formularies

• Provider networks

• Copayments

In 2025, the market remains highly competitive, and some insurers adjust benefits to control costs. If you don’t pay attention during Open Season, you could be locked into a plan that suddenly doesn’t meet your needs.

Under PSHB, this becomes even more complex. You must evaluate:

• Whether your PSHB plan automatically includes a Medicare Advantage path.

• Whether you want to opt out of that and stick with Original Medicare plus PSHB.

Supplemental Benefits Sound Nice But Can Be Misleading

Medicare Advantage plans often highlight their extra benefits, like dental, vision, hearing aids, fitness memberships, and over-the-counter allowances.

But these benefits often come with limitations:

• Dental coverage might be limited to cleanings and simple extractions.

• Vision benefits might only cover an eye exam and basic lenses.

• OTC allowances may require purchasing from select vendors.

While PSHB plans may not highlight these extras as much, the medical coverage tends to be more consistent and predictable—especially when paired with Medicare.

If you’re choosing a plan in 2025 based solely on perks, you risk losing sight of what matters most: full and flexible medical care.

Medicare Advantage Enrollment Comes with Lock-In Periods

One overlooked issue is how long you’re locked into a Medicare Advantage plan once you join.

For most people, after enrolling during the Medicare Open Enrollment Period (October 15 to December 7), you’re in that plan for the entire calendar year. You can only make changes during a limited Medicare Advantage Open Enrollment Period (January 1 to March 31) or if you qualify for a Special Enrollment Period.

If you later decide Medicare Advantage isn’t working for you, switching back to Original Medicare and your PSHB plan may not be as simple as you hoped. You may also face restrictions rejoining Medicare drug coverage or getting a Medigap policy (if relevant).

The PSHB and Medicare Advantage Intersection Is Still New

Because PSHB is launching in 2025, many of the rules and dynamics around how it interacts with Medicare Advantage are being clarified in real time. That means:

• PSHB plans may still be adjusting their Medicare Advantage offerings.

• Support lines may offer limited or inconsistent information.

• Your plan’s integration with Medicare may vary year to year.

If you are considering switching to a Medicare Advantage plan under PSHB, it’s vital to get updated information and confirm every detail before making a change.

Why a Careful Review Matters This Year More Than Ever

2025 isn’t just another year of Medicare decisions. The entire system is shifting for Postal retirees. The PSHB transition requires you to reevaluate your coverage, Medicare enrollment, and coordination choices.

Ask yourself:

• Does my current provider accept the Medicare Advantage plan I’m considering?

• Will I be traveling or living in another state for part of the year?

• Do I understand the referral and prior authorization requirements?

• Will I be able to change my plan if I’m unhappy mid-year?

These are not minor details. They can shape your care experience and costs for the next 12 months or more.

Reviewing the Bigger Picture Before You Decide

Medicare Advantage plans in 2025 may continue to grow in popularity, but that doesn’t mean they’re the right choice for everyone—especially PSHB annuitants.

You now have new responsibilities:

• Enroll in Medicare Part B if you’re eligible (unless exempt).

• Understand whether your PSHB plan includes or offers Medicare Advantage.

• Confirm provider access, costs, and benefits.

Choosing Medicare Advantage can work for some, but only if you fully understand the tradeoffs. Your access to care, control over costs, and ability to change plans all depend on decisions made during a short window.

Don’t be swayed by marketing. Get the facts, compare all options, and when in doubt, talk to someone who understands the PSHB-Medicare relationship in detail.

Talk With a Licensed Expert Who Knows PSHB

The Medicare Advantage conversation has a lot of layers, especially under PSHB in 2025. Before you enroll, take time to understand your full range of benefits, restrictions, and responsibilities.

If you want help comparing your PSHB options with Medicare Advantage or traditional Medicare, speak with a licensed agent listed on this website. They can clarify:

• Your eligibility and timelines.

• How your current doctors fit into different plan types.

• The actual cost difference between options.

It’s your health and your money. Make sure you’re choosing with full awareness, not just what looks good in a brochure.