Key Takeaways

  • While copayments under Postal Service Health Benefits (PSHB) plans may appear manageable at first glance, repeated medical visits in 2025 can lead to significant out-of-pocket expenses.

  • You need to evaluate how copayments interact with other cost-sharing elements like deductibles and coinsurance to avoid unexpected healthcare bills.

Why the Familiar $30–$40 Copayment Isn’t the Whole Story

You’re used to thinking of copayments as straightforward: a fixed amount for a doctor’s visit or a prescription. With PSHB plans in 2025, this is still partly true—but the structure behind those copays is more complex. What’s changing is how often those seemingly small fees start to accumulate.

Copayments under PSHB generally range from $20 to $40 for primary and specialty care, and from $50 to $150 for urgent or emergency care. If you visit the doctor once or twice a year, these fees may feel insignificant. But the reality is that many retirees and employees need more frequent visits due to age, chronic conditions, or family needs.

That’s when the math shifts. Suddenly, a routine schedule of appointments can rack up costs quickly, especially when combined with coinsurance, deductibles, and non-covered services.

What Happens After the Third or Fourth Visit?

If you see a specialist four times in a month for follow-up care, a $40 copayment adds up to $160 right away. Add an imaging test or lab work that includes coinsurance, and you’re looking at hundreds more—none of which are softened by the term “copay.”

These recurring payments often go unnoticed until you review your year-end statements. And because most PSHB plans separate services by tiers (primary, specialty, urgent, emergency, telehealth, etc.), the payment model becomes layered.

Here’s where many retirees get caught off guard:

  • Multiple services per visit (e.g., labs and consultations)

  • Tiered copayments (primary care may be lower than urgent care)

  • Repeat services within short timeframes, which copays don’t discount

Even though PSHB aims to make healthcare more affordable, repeated visits create a blind spot. Especially if you’re not factoring in other ongoing health costs.

Medicare Part B Integration Doesn’t Eliminate Copayments

In 2025, many PSHB plans are designed to coordinate with Medicare Part B. If you’re enrolled in both, you may benefit from lower out-of-pocket costs overall. But that doesn’t mean copayments disappear entirely.

Depending on the plan, some services covered by Medicare Part B may have waived or reduced copays when processed through PSHB. However, if Medicare is the primary payer and PSHB secondary, any remaining balance may still result in a copayment.

And keep in mind:

  • Not all plans eliminate cost-sharing for Medicare enrollees

  • Some plans still assign copays for services Medicare doesn’t cover

  • You may also face out-of-pocket limits that reset annually, which copays contribute toward but don’t cap immediately

Coordination helps, but it doesn’t erase the layered fee structure you face.

PSHB Plans Group Services Differently—And It Affects What You Pay

One key change in 2025 is how services are grouped. Under PSHB, plans tend to break healthcare visits into more categories, each with its own copay amount. That means your share of costs depends not only on the number of visits but also on what type of care you receive.

Common service tiers include:

  • Primary care visits – lower copayment

  • Specialist visits – mid-range copayment

  • Urgent care – higher copayment

  • Emergency room visits – highest copayment

  • Telehealth – often lower, but not always free

Because copays differ by category, the mix of care you receive greatly affects your total out-of-pocket spending.

For instance, four urgent care visits at $60 each cost you more than six primary care visits at $20 each. It’s not just about frequency—it’s about care type.

Adding Dependents Increases Total Copayment Exposure

If you’re enrolled in a Self Plus One or Self and Family plan, every dependent’s use of services adds more potential copayments to your household’s budget. That means you need to think beyond just your own care needs.

For families with:

  • Children requiring frequent pediatric visits

  • A spouse managing a chronic condition

  • Aging parents under your care

… the compounded copayment amounts can strain your monthly budget quickly.

What looks like a $40 visit becomes $200+ per month when five family members use services. If you aren’t tracking the full picture, the surprise comes when the explanation of benefits (EOB) statements arrive.

Deductibles Still Apply in Many Scenarios

Another detail to keep in mind: Copayments don’t always apply toward your plan’s deductible.

High-deductible PSHB options often exclude copayments from the deductible calculation. This means that even after you’ve paid out hundreds in copays, you may still owe full price for services until the deductible is met.

Here’s how this works:

  • Copays = flat fees, typically not credited toward the deductible

  • Deductibles = thresholds you must meet before full coverage kicks in

  • Coinsurance = percentage you pay after meeting the deductible

These work together—but not always to your advantage. Without reading the fine print, it’s easy to assume copays are chipping away at your deductible, when they’re not.

PSHB and the Impact of Annual Out-of-Pocket Maximums

Every PSHB plan includes an annual out-of-pocket maximum, but many members misunderstand how this works.

In 2025:

  • Self Only in-network maximums may reach $7,500

  • Self Plus One and Self and Family plans may reach $15,000

Copayments do count toward these limits—but only after you’ve paid them. And most members never reach the out-of-pocket maximum unless a major event (hospitalization, surgery, etc.) occurs.

This means the majority of your copayments in a year simply stack up without ever triggering relief from the cap. For most, that cap is a formality, not a reachable benchmark.

Telehealth May Help—but Doesn’t Replace In-Person Care for Everyone

Telehealth options under PSHB are expanding in 2025, with some plans offering lower copayments for virtual visits. That’s useful if you:

  • Have mobility limitations

  • Need mental health support

  • Want to consult a provider quickly for minor issues

However, telehealth doesn’t replace:

  • Imaging and diagnostic tests

  • In-office procedures

  • Lab work

  • Physical exams

So while it’s a helpful tool for some, it won’t necessarily reduce your copayment load significantly unless you can shift a large portion of your care online—which is rarely the case.

Watch Out for the Lab Work and Imaging Trap

One of the most underestimated contributors to unexpected charges is diagnostic testing. Many retirees and employees think of a doctor’s visit as one cost—but if your provider orders blood work or imaging, these may trigger additional copayments or coinsurance.

Under PSHB plans, these services may fall into different tiers or have separate cost-sharing requirements:

  • Labs may require coinsurance, even if ordered during a regular visit

  • Imaging like X-rays or MRIs may have their own copayment or cost-sharing tier

So a $30 visit can quickly grow to $130+ when all related services are billed.

You Need a Strategy—Not Just a Budget

The best approach in 2025 isn’t just to budget for expected care—it’s to plan around how you’ll use your benefits. This means:

  • Estimating your total care needs over the year, not per visit

  • Understanding your plan’s copayment structure

  • Reviewing past usage patterns to anticipate future visits

  • Coordinating Medicare benefits if applicable

  • Checking how dependent usage affects your household costs

Your benefits package is valuable, but only if you fully understand where your money is going.

Don’t Let Copayment Math Derail Your Healthcare Planning

It’s easy to look at your PSHB copayments and feel confident—they’re fixed, they’re listed upfront, and they seem reasonable. But when you start layering services, adding dependents, and dealing with chronic care or aging, those small numbers quickly become larger sums.

If you’re unsure whether your plan aligns with your needs or feel like your copayments are adding up too fast, get in touch with a licensed agent listed on this website. They can walk you through your options and help you adjust before small costs turn into larger financial stress.