Key Takeaways

  • Even though PSHB premiums may appear straightforward, the full cost of coverage includes deductibles, coinsurance, copayments, and other out-of-pocket expenses that are not obvious at first glance.

  • Understanding how these hidden costs interact with Medicare Part B enrollment in 2025 is essential for evaluating the real value and affordability of your PSHB plan.

Understanding the Layers of PSHB Costs

When you look at your Postal Service Health Benefits (PSHB) plan, the first thing you probably notice is the premium. It may seem like that number tells you what you’re paying for your health insurance, but in 2025, that’s far from the full story. PSHB costs are layered, and many of those layers don’t reveal themselves until you’re already using care—or paying more than expected.

To make better choices, you need to understand all the ways a PSHB plan can impact your wallet throughout the year.

What You’re Actually Paying For in 2025

Your total cost under a PSHB plan comes from multiple components. While some of them are upfront, others emerge as you use healthcare services. Here’s the breakdown:

Premiums (Your Monthly Contribution)

This is the base cost you pay every month just to keep your coverage active. For annuitants, the government covers about 70% of this amount. The rest comes out of your retirement check. In 2025, monthly annuitant contributions are averaging:

  • Self Only: Over $240

  • Self Plus One: Over $520

  • Self and Family: Over $560

But remember: this is just the beginning.

Deductibles

Deductibles are what you must pay out-of-pocket each year before your plan begins covering costs. Depending on your PSHB plan type, in-network deductibles can range from $350 to $1,500. High-deductible plans can go even higher.

If you have a family plan, your combined deductible could reach $3,000 or more. This amount resets every year, meaning you face it again starting January 1.

Copayments

Copayments are fixed fees you pay for specific services like:

  • $20–$40 for primary care

  • $30–$60 for specialists

  • $100–$150 for emergency room visits

You pay these at the time of service, and they do not count toward your deductible in many plans.

Coinsurance

Coinsurance is a percentage of the cost you share with the plan once your deductible is met. For example:

  • 20%–30% for in-network services

  • 40%–50% for out-of-network care

This can be especially costly for specialist visits, surgeries, and lab work. The percentage may seem small, but when the service costs thousands, your share can be significant.

Out-of-Pocket Maximums

This is the maximum amount you’ll pay in a year for covered services. Once you reach this limit, the plan pays 100% of allowed charges. In 2025, this cap varies widely:

  • Self Only: Around $5,000 to $7,500

  • Family Plans: $10,000 to $15,000

This limit only applies to covered in-network services. Out-of-network expenses often have a separate, much higher limit—or none at all.

Where Medicare Part B Comes In

For Medicare-eligible retirees, enrolling in Medicare Part B can significantly reduce your PSHB out-of-pocket expenses. As of 2025, Part B enrollment is required for most annuitants and family members who:

  • Turned 65 before January 1, 2025, and are not exempt

  • Are covered under PSHB as annuitants

Plans often integrate with Medicare to provide added value:

  • Reduced or waived deductibles

  • Lower copayments

  • Decreased coinsurance

  • Enhanced prescription drug benefits under Medicare Part D EGWP

However, you must factor in the Medicare Part B premium, which is $185 in 2025. That monthly amount adds to your total cost, but many PSHB plans reimburse part or all of it—another hidden variable you must confirm.

What Costs Are Often Overlooked

Several types of expenses often catch enrollees by surprise, even in plans that seem generous on paper:

  • Out-of-network charges: If your provider isn’t in your plan’s network, you may face much higher coinsurance or full charges.

  • Prescription tiers: Medication costs are categorized by tier, and higher-tier drugs come with steep copayments or coinsurance.

  • Urgent care and ER visits: These can pile up quickly, especially when traveling.

  • Rehabilitation or specialty therapies: Physical therapy, speech therapy, or mental health services often have separate limits, copays, or session maximums.

How These Costs Add Up Over Time

Imagine you use healthcare modestly throughout the year—two doctor visits, one specialist, some labs, a few prescriptions, and one ER trip. You may already be looking at several hundred dollars in out-of-pocket costs, even before considering coinsurance on lab tests or specialty drugs.

Add a chronic condition or a minor surgery, and your annual spending could quickly approach your out-of-pocket maximum.

The illusion of a low-cost plan can evaporate once you start adding everything together.

Yearly Budgeting: Monthly vs. Annual Costs

To truly evaluate your PSHB plan, it’s better to think in yearly terms rather than just monthly. Here’s what to consider:

  • Annual Premiums: Multiply your monthly share by 12.

  • Expected Out-of-Pocket: Estimate what you typically pay in deductibles, copayments, and coinsurance.

  • Part B Premiums (if enrolled): Multiply $185 by 12 for the yearly total.

  • Hidden variables: Factor in possible emergency visits or drug cost changes.

This will give you a clearer sense of what your plan really costs you.

How to Reduce the Financial Shock

If you want to protect your budget from unexpected medical bills, there are a few proactive steps you can take:

  • Choose in-network providers only. Even if you love a doctor who’s out-of-network, switching could save you thousands.

  • Use preventive care benefits. These are often covered at 100%, including annual wellness exams and certain screenings.

  • Review the plan brochure every year. Benefits, deductibles, and coinsurance amounts can change annually.

  • Enroll in Medicare Part B if required. Most 2025 PSHB plans are designed to work better when coordinated with Medicare.

  • Consider plan reimbursement offers. Some plans offer Medicare Part B premium reimbursements. Check if yours does.

Enrollment Deadlines and Annual Review

You can only change your PSHB plan during the Open Season, which takes place annually from November to December. This is your only chance—outside of qualifying life events—to adjust for the upcoming year.

Before the Open Season, you should receive a plan brochure outlining any changes in:

  • Premiums

  • Copayments and coinsurance

  • Covered services

  • Prescription formularies

It’s critical to read it thoroughly and compare it with the previous year to see if your current plan still fits your needs.

Paying More Doesn’t Always Mean Getting More

Some PSHB plans with higher premiums may offer lower deductibles and better cost-sharing. But that doesn’t mean you’re always getting better coverage for the extra dollars.

  • A plan with a low deductible may have higher prescription drug costs.

  • A plan with great preventive coverage may limit specialty care access.

  • A plan that fully reimburses Part B may have a narrower provider network.

Balancing these factors is essential to ensure your spending aligns with your care needs.

Understanding PSHB Cost Structure Can Protect Your Budget

When you understand how your PSHB plan breaks down its costs—beyond the monthly premium—you gain control. Knowing what to expect with deductibles, copayments, coinsurance, and integration with Medicare gives you the power to make smarter decisions and avoid budget shocks.

You don’t have to decode this alone. Reach out to a licensed agent listed on this website for help reviewing your 2025 PSHB options and finding a plan that fits both your health needs and your wallet.