Key Takeaways

  • Medicare Advantage (Part C) plans in 2025 often leave out or limit certain key benefits that Postal Service Health Benefits (PSHB) enrollees may expect from traditional Medicare.

  • When you combine a PSHB plan with Medicare Advantage, you may encounter denied coverage or higher costs when it matters most—especially for out-of-network providers, post-acute care, and skilled nursing.

Understanding the Role of Part C in Your PSHB Coverage

You might assume that enrolling in a Medicare Advantage plan strengthens your PSHB coverage. After all, both are designed to provide robust healthcare protection. But in 2025, the reality is that some Part C plans are excluding or restricting key benefits—and many Postal retirees are discovering this too late.

PSHB plans are federally regulated and tailored for Postal Service workers and retirees. Medicare Advantage, however, is managed by private companies under Medicare rules. While both are part of your retirement healthcare toolkit, they don’t always coordinate well. That’s why it’s critical to understand what Part C may leave out.

What Part C Plans May Not Cover in 2025

Limited Network Access

One of the biggest surprises for many enrollees is how restrictive Part C networks can be.

  • Out-of-network services often aren’t covered at all, or only partially covered.

  • Nationwide provider access is not guaranteed—even if your PSHB plan would normally cover a broader range of providers.

  • Emergency-only coverage may apply outside a plan’s service area.

This can be particularly problematic if you split time between states, travel often, or need access to specialty care not offered within your local network.

Reduced Skilled Nursing and Rehabilitation Benefits

Many Part C plans impose stricter rules around post-acute care:

  • Some plans limit the number of covered days in a skilled nursing facility.

  • Others require prior authorization for rehab services that Original Medicare would have covered automatically.

  • The $2,000 cap on drug costs under Part D doesn’t always translate into adequate support for drugs used in skilled nursing settings.

When paired with a PSHB plan, these limitations can result in confusing denials and unexpected out-of-pocket charges.

Home Health Care and Durable Medical Equipment (DME)

In 2025, Part C plans continue to have the ability to restrict the scope of services like home health care and DME:

  • Coverage might only apply if services are provided by in-network suppliers.

  • Some items, such as advanced wheelchairs or oxygen supplies, may be subject to restrictive criteria.

If your PSHB plan expects Medicare to cover these first, gaps may emerge.

Key Coordination Issues Between PSHB and Part C

Who Pays First Can Get Complicated

Coordination of benefits is usually straightforward with Original Medicare and PSHB. But with Medicare Advantage, things shift:

  • Part C becomes the primary payer, but doesn’t always follow the same rules as Original Medicare.

  • Your PSHB plan may expect Medicare to cover more than the Part C plan actually allows.

  • Claim denials can occur when your PSHB plan assumes coverage that Part C doesn’t offer.

This creates a disconnect where you’re caught in the middle, facing delays, appeals, or unexpected costs.

Prior Authorization Barriers

Most Medicare Advantage plans in 2025 require prior authorization for a wide array of services, including:

  • Imaging tests (MRIs, CT scans)

  • Surgeries

  • Durable medical equipment

  • Skilled nursing and inpatient rehab

Even if your PSHB plan would cover the service outright, the Medicare Advantage plan must approve it first. This can delay care or even lead to denial.

Supplemental Benefits and Their Fine Print

Many retirees are attracted to Medicare Advantage plans due to extras like dental, vision, or wellness programs. But these benefits:

  • Are not standardized across plans.

  • May be limited in scope or tied to provider networks.

  • Might not integrate with your PSHB benefits at all.

You may think you’re doubling up on services, but overlapping coverage doesn’t always mean double the benefit.

Why You Might Not Notice the Gaps Until It’s Too Late

In many cases, Part C plans perform well for basic services. But it’s when your healthcare needs increase that gaps appear:

  • A hospitalization exposes limited inpatient rehab coverage.

  • A sudden move reveals your provider is out-of-network.

  • A serious illness uncovers strict prior auth policies that delay urgent care.

Because these issues tend to arise during periods of high stress, many retirees don’t recognize the shortfalls until they’re already facing them.

What You Can Do to Protect Yourself in 2025

Review Plan Documents Thoroughly

Your Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents detail what’s included—and more importantly, what isn’t. Key areas to focus on:

  • Coverage for skilled nursing, home health, and rehab

  • Provider network size and flexibility

  • Authorization requirements for procedures and equipment

Don’t assume a benefit exists just because it did under Original Medicare.

Understand Your Rights and Appeal Options

Medicare Advantage enrollees have:

  • The right to appeal denied services

  • Access to a grievance process for delays or substandard care

  • The option to switch plans during the October 15–December 7 Open Enrollment Period

If you’re already enrolled in a Part C plan and encounter limitations, act quickly to understand your next steps.

Consider the Value of Staying With Original Medicare

For some PSHB enrollees, sticking with Original Medicare (Parts A and B) plus their PSHB plan offers more predictability:

  • No prior authorization for most services

  • Wider provider access

  • Seamless coordination with PSHB benefits

While you might miss out on some extras, the trade-off is usually fewer headaches during major health events.

The 2025 PSHB-Medicare Environment: What Changed?

The PSHB transition in 2025 has brought heightened attention to Medicare Part B enrollment and drug coverage integration. But it has also made the limitations of pairing PSHB with Part C plans more visible:

  • Many retirees were automatically enrolled in PSHB plans assuming full coordination with their existing Part C plan.

  • Others mistakenly opted for Medicare Advantage thinking it would enhance PSHB, only to experience reduced flexibility.

The PSHB program expects coordination with Medicare Parts A and B. If you substitute a Medicare Advantage plan instead of enrolling in Part B, some of the expected benefits may be reduced or lost.

When to Reevaluate Your Enrollment Choices

The best time to rethink your setup is before an emergency arises. Consider doing a benefits checkup during the summer or early fall, before the Medicare Open Enrollment period begins in October.

Questions to ask yourself:

  • Are my providers in-network for my Part C plan?

  • Does my PSHB plan expect coordination with Original Medicare?

  • Are there services I may need in the next year (rehab, surgery, skilled nursing)?

  • Do I fully understand prior authorization requirements?

Taking the time now can spare you from costly surprises later.

What This Means for Your Retirement Healthcare

For Postal retirees, 2025 is a year of transition. With the PSHB program now in effect, integrating it with Medicare has become more complex. If you choose to layer in a Medicare Advantage plan, you must be prepared to:

  • Navigate network restrictions

  • Manage more paperwork and preapprovals

  • Understand what is and isn’t covered

Ultimately, your goal should be a healthcare strategy that gives you peace of mind, not one that adds confusion or unexpected expenses.

Make Sure Your PSHB Plan Works With Your Medicare Coverage

The appeal of Medicare Advantage is strong, but it doesn’t always complement PSHB the way you expect. If you’re enrolled in a Part C plan or considering one, take time to review how it aligns with your PSHB benefits.

The last thing you want is to find out a service isn’t covered when you need it most. Reach out to a licensed agent listed on this website to help assess your setup. They can walk you through options, clarify potential conflicts, and help you make adjustments before enrollment windows close.