Key Takeaways

  • Reaching your deductible in a PSHB plan does not automatically mean your out-of-pocket costs will decrease significantly.

  • Coinsurance, copayments, out-of-network charges, and tiered drug pricing still apply after the deductible is met, making it critical to understand your plan’s full structure.

What the PSHB Deductible Really Covers

In 2025, Postal Service Health Benefits (PSHB) plans include deductibles that vary significantly depending on whether you’re enrolled in Self Only, Self Plus One, or Self and Family coverage. Deductibles in low-deductible PSHB plans generally fall between $350 and $500 for in-network care. High-deductible options can climb to $1,500 or even more.

But hitting that deductible doesn’t give you a green light to coast for the rest of the year. Many PSHB enrollees mistakenly believe that once they meet their deductible, their costs will drop dramatically or vanish altogether. That isn’t the case.

Deductibles cover only a portion of your financial responsibility. After you hit that threshold, you enter the next phase of cost sharing, which involves coinsurance, copayments, and potential charges for services not fully covered or out-of-network.

Coinsurance: The Real Cost Driver After Deductibles

Once your deductible is met, you typically transition to coinsurance—a percentage of the cost you continue to pay for covered services. In 2025, coinsurance rates in PSHB plans are often:

  • 10% to 30% for in-network services

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

This means that even after you’ve met your deductible, a hospital bill of $5,000 might still result in a $500 to $1,500 out-of-pocket charge, depending on your plan’s structure.

Coinsurance continues until you reach your out-of-pocket maximum (OOPM), which in PSHB plans typically ranges from:

  • $5,000 to $7,500 for Self Only in-network

  • $10,000 to $15,000 for Self Plus One or Self and Family in-network

That’s a long financial journey after meeting your deductible.

Copayments Don’t Disappear Post-Deductible

Another area of confusion is copayments. These flat-rate fees for specific services—like office visits, urgent care, or prescriptions—do not go away once you hit your deductible.

For instance, specialist visits often carry copays ranging from $30 to $60, and emergency room visits may involve $100 to $150 fees. These amounts still apply after the deductible is met, and they don’t count toward your deductible but do count toward your OOPM.

If you or your family make frequent visits throughout the year, these charges can add up quickly—even after you’ve satisfied your deductible early in the year.

Tiered Drug Pricing Continues Throughout the Year

Prescription drug costs in PSHB plans are typically structured around tiered pricing. These tiers separate drugs into categories such as:

  • Tier 1: Generic

  • Tier 2: Preferred Brand

  • Tier 3: Non-Preferred Brand

  • Tier 4: Specialty Drugs

Even if your deductible is met, these tiers remain in effect. A Tier 3 drug might still cost you significantly more than a Tier 1 alternative.

Many PSHB plans also have a separate prescription drug deductible or cost-sharing arrangement that continues even after you’ve met your medical deductible. If your plan integrates Part D coverage through a medicare EGWP (Employer Group Waiver Plan), the $2,000 out-of-pocket prescription cap in 2025 provides relief, but only once you’ve spent that much in total drug costs.

Out-of-Network Pitfalls After the Deductible

Some enrollees assume that once the deductible is met, all services are covered equally—even those from out-of-network providers. That assumption can lead to unpleasant surprises.

In PSHB plans, out-of-network services generally involve:

  • Higher coinsurance (often 40% to 50%)

  • Separate out-of-network deductibles, which must be met in addition to the in-network deductible

  • Separate, higher out-of-pocket maximums, usually ranging from $10,000 to $20,000 or more

Even after meeting your in-network deductible, if you seek care outside your plan’s network, you’re effectively starting over.

Services That Aren’t Subject to the Deductible

You may be surprised to learn that many PSHB services are not subject to the deductible at all. These typically include:

  • Preventive services (like screenings and immunizations)

  • Telehealth visits

  • Behavioral health counseling

  • Generic prescriptions

While this can reduce your immediate out-of-pocket expenses, it can also delay how quickly you meet your deductible. For example, if most of your healthcare spending goes toward services that bypass the deductible, you may not reach the threshold until much later in the year—if at all.

This also means you remain in the pre-deductible cost-sharing phase for longer, continuing to pay the full cost for services that do apply to the deductible.

Out-of-Pocket Maximums Are Still a Moving Target

The out-of-pocket maximum (OOPM) is the ceiling that limits how much you spend in a calendar year for covered, in-network services. In 2025, the typical PSHB OOPM for Self Only coverage ranges from $5,000 to $7,500. For Self Plus One and Self and Family, it can range from $10,000 to $15,000.

However, reaching your OOPM is not guaranteed. Many enrollees never meet it, especially if their healthcare needs are moderate. And unlike the deductible, which is usually front-loaded (due to a few early expenses), the OOPM accumulates more slowly.

This means that even after meeting your deductible early in the year, you might continue to pay:

  • 20% coinsurance on expensive diagnostic tests

  • $40 specialist copays

  • $60 urgent care copays

…all year long, unless your combined expenses eventually hit the OOPM.

Don’t Confuse Deductibles With Maximums or Caps

The deductible is just one component of your cost-sharing responsibilities. It doesn’t cap your costs—it simply starts the meter.

Here’s a clearer breakdown of how PSHB costs stack up in 2025:

  • Premium – Paid monthly, no matter what

  • Deductible – The amount you pay out-of-pocket for services before cost-sharing begins

  • Coinsurance – The percentage of service costs you pay after meeting the deductible

  • Copayments – Flat fees for certain services that often apply throughout the year

  • OOPM – The absolute limit on your cost-sharing obligations in a given year

Understanding the difference between these layers is essential. Misinterpreting them could lead to poor budgeting and unexpected bills.

Medicare Integration Complicates the Deductible Picture

If you’re a Medicare-eligible annuitant enrolled in a PSHB plan, you likely also have Medicare Part A and Part B. In this scenario, Medicare pays first, and your PSHB plan pays second.

For many services, Medicare’s primary payment wipes out your PSHB deductible entirely. But that doesn’t mean all deductibles vanish. For example:

  • Some services not fully covered by Medicare may still trigger PSHB deductible charges

  • Prescription costs through the integrated Medicare Part D EGWP still accumulate

Also, not all PSHB plans waive deductibles or coinsurance when combined with Medicare, so it’s critical to review your specific plan’s coordination rules.

Planning Ahead to Reduce Surprises

To make the most of your PSHB coverage in 2025:

  • Review your plan brochure carefully to understand what is and isn’t subject to the deductible

  • Track your spending so you know where you stand relative to both your deductible and OOPM

  • Stay in-network whenever possible to avoid dual deductibles and higher coinsurance

  • Use preventive care and telehealth, which often bypass deductibles entirely

  • Speak with a licensed agent listed on this website to clarify the financial implications of your current PSHB plan

Deductibles are just the beginning of your cost-sharing journey—not the end.

Your Deductible Isn’t the Finish Line—It’s the Starting Gate

In PSHB plans, hitting your deductible might feel like a milestone, but it doesn’t guarantee a reprieve from out-of-pocket expenses. Coinsurance, copays, and uncovered services still play a major role in your total annual spending.

It’s essential to approach your health care coverage with realistic expectations and a solid understanding of how each cost component fits together. Don’t wait until an unexpected bill lands in your mailbox—get ahead of the game.

To ensure you’re in the best financial position this year, reach out to a licensed agent listed on this website. They can help you evaluate whether your current PSHB plan meets your needs or if another option might reduce your exposure to long-term costs.