Key Takeaways

  • In 2025, many Postal Service Health Benefits (PSHB) participants are unaware of the full extent of their annual healthcare costs, including rising contributions, coinsurance, and out-of-pocket maximums.

  • Misunderstandings about how premiums, deductibles, and cost-sharing interact often lead to underestimating actual yearly expenses.

Why PSHB Costs Feel Clear—But Often Aren’t

On paper, your Postal Service Health Benefits plan might seem straightforward. You see a monthly premium, a deductible amount, and a few copayment rates. But that simplicity hides a more complex web of costs that shift depending on how much healthcare you use, how your plan handles cost-sharing, and what Medicare coverage (if any) you also hold.

For many PSHB participants in 2025, this leads to confusion. The numbers seem to line up neatly—but by the end of the year, your budget may not agree.

The Full Picture: What You’re Actually Paying

Health plan costs aren’t just about your premiums. Your real financial exposure includes:

  • Biweekly or monthly premium contributions (employee or annuitant share)

  • Deductibles for services before cost-sharing begins

  • Copayments for routine services like primary care and urgent care

  • Coinsurance for services charged as a percentage after the deductible

  • Prescription drug costs (including caps and tiered pricing)

  • Annual out-of-pocket maximums

These elements work together to define your real cost burden. And depending on how often you need care, what providers you use, and whether you have Medicare Part B, your annual costs can vary significantly from your expectations.

Understanding Your Biweekly Contributions in 2025

As of 2025, annuitants in the PSHB program typically pay the following approximate biweekly amounts:

  • Self Only: $111.26

  • Self Plus One: $240.49

  • Self and Family: $261.70

These translate into monthly costs that can exceed $500 for family coverage. While the government covers around 70% of the total plan premium, your share adds up over time. For instance, the Self Plus One option now crosses $6,000 a year for many annuitants.

Despite this, some enrollees believe their share is much lower because they remember past years’ costs, or because the deductions are automatic and biweekly. It’s not uncommon to lose sight of the annual total.

The Deductible Illusion: It’s Not Always Straightforward

Your deductible represents the amount you must pay before your plan starts covering a percentage of your costs. For many 2025 PSHB plans, deductibles fall into the following general ranges:

  • Low-deductible plans: $350 to $600 (Self Only)

  • High-deductible plans: $1,500 to $2,000 (Self Only)

However, what many enrollees overlook is:

  • Separate deductibles for in-network vs. out-of-network care

  • Family deductibles that require multiple people to reach thresholds before coverage kicks in

  • Pharmacy deductibles, which may be separate from medical deductibles

So even if your main deductible seems low, other thresholds might need to be met first, especially if you have family coverage.

Coinsurance: The Quiet Percentage That Adds Up

Coinsurance is a percentage-based cost you pay after you meet your deductible. Many PSHB plans in 2025 include coinsurance rates such as:

  • 10% to 30% for in-network services

  • 40% to 50% for out-of-network services

This can catch you off guard. For example, a $2,000 diagnostic test at a facility that charges coinsurance can result in a $400 to $600 bill—even after your deductible is paid.

Coinsurance is particularly tricky for outpatient surgery, advanced imaging (MRI, CT scans), or hospital stays. If you don’t anticipate needing these services, you may underestimate your annual exposure.

Copayments: Flat Fees That Stack Up

Unlike coinsurance, copayments are flat fees for services such as:

  • Primary care visits: Typically $20 to $40

  • Specialist visits: Often $30 to $60

  • Urgent care: $50 to $75

  • Emergency room: $100 to $150

At first glance, these seem manageable. But repeated visits throughout the year add up. A few primary care visits, a couple of urgent care trips, and a specialist referral can total hundreds quickly.

And if your plan increases copays annually without notice (as some have in 2025), you may be paying more this year than you did in 2024, even if your health needs haven’t changed.

Prescription Drug Costs: Don’t Overlook the Tiers

Drug coverage under PSHB in 2025 is integrated with Medicare Part D for eligible enrollees. This means:

  • Insulin costs are capped at $35 per month

  • Your out-of-pocket prescription drug costs are capped at $2,000 annually

However, this applies only if you have Medicare Part B and remain enrolled in the plan’s drug coverage.

For others, costs follow a tier system:

  • Generic drugs: Lowest copay

  • Preferred brand-name drugs: Higher copay or coinsurance

  • Non-preferred and specialty drugs: Significantly higher costs

If you take multiple medications or use specialty drugs, your pharmacy spending can be one of your largest healthcare expenses of the year.

Medicare Integration: The Cost-Sharing Game Changer

If you’re Medicare-eligible and enrolled in Part B, your PSHB plan may reduce or even waive:

  • Deductibles

  • Copayments

  • Coinsurance

Some plans also reimburse part of your Part B premium or offer expanded pharmacy networks. In 2025, these benefits make enrolling in Part B more financially beneficial for many retirees.

However, not all annuitants are aware of this integration. Some decline Part B, thinking it’s an extra expense, without realizing the savings they miss within their PSHB plan.

Annual Out-of-Pocket Maximums: Your True Safety Net

Every PSHB plan includes an out-of-pocket limit. Once you reach it, the plan covers 100% of most additional covered expenses for the year.

In 2025, in-network out-of-pocket maximums generally fall around:

  • $7,500 for Self Only

  • $15,000 for Self Plus One and Self & Family

But there are caveats:

  • Out-of-network limits are often higher or unlimited

  • Not all costs (e.g., premiums, out-of-network charges, non-covered services) count toward the max

Many enrollees think this figure represents their full exposure, but in reality, your actual maximum includes premiums, uncovered services, and potentially high out-of-network charges.

Cost Misunderstandings That Are Common in 2025

You might be underestimating your PSHB costs this year if:

  • You don’t regularly total your biweekly or monthly premium deductions

  • You think your deductible is the same for every type of service

  • You confuse copayments with coinsurance

  • You forget to factor in recurring prescription drug costs

  • You assume your annual out-of-pocket maximum includes all costs

  • You haven’t reviewed your plan’s 2025 brochure or updated benefit terms

What You Can Do Right Now to Get Clarity

Getting a handle on your costs doesn’t have to be overwhelming. Here are a few steps you can take:

  • Use your plan’s online cost estimator tool

  • Request your year-to-date spending summary from your health plan

  • Compare your current plan with others during the November-December Open Season

  • Talk to a licensed agent listed on this website to better understand your plan’s details

  • Keep a simple healthcare spending log to track recurring expenses

Even one unexpected surgery, hospital stay, or new prescription could shift your year-end costs dramatically.

Why Knowing the True Cost Matters More Than Ever in 2025

With healthcare costs rising and plan structures becoming more layered, your awareness of how PSHB costs are structured can directly affect your financial planning. A plan that seemed affordable based on its premium alone might be costlier than you realize when you look at total usage.

The good news? You have tools, support, and time to assess your plan and adapt. Understanding the real cost of your PSHB plan is the first step toward making it work better for your needs.

If you’re uncertain about how your plan works or what options could better serve you in 2025, consider speaking to a licensed agent listed on this website for personalized assistance.