Key Takeaways

  • Enrolling in Medicare does not automatically ensure full integration with your PSHB coverage—you must take action to avoid gaps or denied claims.

  • Certain timelines, eligibility exceptions, and coordination rules make it essential to understand how PSHB and Medicare Parts A and B interact in 2025.

Why Medicare Enrollment Doesn’t Happen Automatically

If you’re nearing age 65 or already enrolled in the Postal Service Health Benefits (PSHB) Program, you might assume that Medicare will integrate with your plan without any extra work. That’s not the case. Medicare enrollment is not automatic unless you’re already receiving Social Security benefits at least four months before turning 65.

This means that even if you’re covered under a PSHB plan, you still need to actively sign up for Medicare Parts A and B through the Social Security Administration.

Who Needs to Enroll and When

In 2025, enrollment in Medicare Part B is mandatory for most Medicare-eligible Postal Service annuitants and their covered family members in order to maintain full PSHB coverage. There are exceptions, but the default expectation is enrollment at age 65, or sooner if you qualify by disability.

You can enroll in Medicare during these time windows:

  • Initial Enrollment Period (IEP): Begins three months before the month you turn 65 and ends three months after.

  • General Enrollment Period (GEP): January 1 to March 31 each year, with coverage starting July 1. Late enrollment penalties may apply.

  • Special Enrollment Period (SEP): If you delayed enrollment because you had qualifying coverage (such as from active employment), you can enroll within 8 months of losing that coverage.

What Happens If You Don’t Enroll

Failing to enroll in Medicare Part B when required can have real consequences:

  • You may lose PSHB medical coverage or face limited benefits.

  • Prescription drug coverage could be affected, especially if your plan includes integration with Medicare Part D.

  • You may owe late enrollment penalties that increase your Medicare premiums permanently.

For 2025, if you’re a Medicare-eligible Postal retiree and you’re not enrolled in Part B without meeting one of the OPM-approved exceptions, you will not receive full PSHB benefits.

How Medicare and PSHB Work Together

The good news is that when you are properly enrolled, Medicare and PSHB plans coordinate to provide more complete and cost-effective coverage.

Medicare Pays First

Once you’re retired and enrolled in Medicare, Medicare becomes the primary payer, and your PSHB plan becomes secondary. This coordination can reduce your:

  • Deductibles

  • Copayments

  • Coinsurance

Many PSHB plans also waive or lower cost-sharing when Medicare is primary.

Prescription Drug Coverage Is Built In

Medicare-eligible annuitants and family members enrolled in PSHB automatically receive prescription drug benefits through an Employer Group Waiver Plan (EGWP). This is a Medicare Part D plan managed through your PSHB provider.

  • You cannot opt into a separate Part D plan and still keep this benefit.

  • Opting out of the EGWP means losing drug coverage under PSHB for the year.

Mandatory Part B Enrollment—With Exceptions

While most Medicare-eligible enrollees must sign up for Part B to maintain PSHB coverage, there are several notable exceptions in 2025:

  • You retired on or before January 1, 2025 and are not already enrolled in Medicare Part B.

  • You’re an employee who was age 64 or older on January 1, 2025.

  • You reside overseas, outside the jurisdiction of Medicare services.

  • You qualify for coverage through the VA or Indian Health Services.

If you meet any of these, you may be exempt from mandatory Part B enrollment—but it’s still wise to consider how declining Part B could affect your costs.

How to Check If You’re Compliant

In 2025, compliance with Medicare enrollment requirements is actively monitored by the Office of Personnel Management (OPM) and your PSHB plan.

You should:

  • Log into your Social Security account to verify enrollment in Medicare Parts A and B.

  • Check with your PSHB plan or the PSHB Navigator Help Line to confirm coordination details.

  • Review your plan materials during Open Season to understand how your benefits will be affected based on your Medicare status.

What If You Missed the Deadline?

If you delayed enrolling in Medicare and missed your Initial Enrollment Period, you may be eligible for the General Enrollment Period (Jan 1–Mar 31) or a Special Enrollment Period under certain conditions.

In the meantime, if you’re not enrolled in Medicare Part B and you’re required to be, you will face:

  • Reduced PSHB benefits

  • No drug coverage under PSHB

  • Higher future premiums due to late penalties

It’s best to act as soon as you become aware of the gap.

Coordinating Enrollment for Covered Family Members

If your family members are also covered under your PSHB plan and are Medicare-eligible, they must each enroll in Medicare Part B unless they also qualify for one of the exceptions.

  • Enrollment is individual, not automatic just because the primary enrollee is covered.

  • Benefits for the family member may be suspended or downgraded without proper Medicare enrollment.

Annual Notices and the Open Season Reminder

Each year, PSHB plans and the OPM issue:

  • ANOC (Annual Notice of Change) letters outlining changes in premiums, coverage, and requirements.

  • Open Season announcements (usually from November to December) giving you the opportunity to switch plans or update your information.

Be sure to:

  • Review any letters or emails regarding your plan’s Medicare requirements.

  • Compare available PSHB options during Open Season, especially if your health needs or Medicare eligibility have changed.

Medicare Premiums and Out-of-Pocket Costs in 2025

Here’s a general look at what Medicare costs you should be prepared for this year:

  • Part A premium: $0 if you have 40 quarters of work history; otherwise, up to $518/month.

  • Part A deductible: $1,676 per benefit period.

  • Part B premium: $185/month standard rate, more for higher incomes.

  • Part B deductible: $257 per year.

  • Part D (EGWP): Included in your PSHB plan with a $2,000 annual cap on out-of-pocket costs.

These figures help you plan but remember that PSHB coordination can reduce your actual out-of-pocket burden significantly.

Action Steps to Secure Coverage

To make sure you’re properly covered in 2025, here’s what you should do:

  • Enroll in Medicare Parts A and B during your Initial Enrollment Period or a Special Enrollment Period.

  • Confirm eligibility if you believe you qualify for an exemption from Part B.

  • Review your PSHB plan for benefits that depend on Medicare coordination.

  • Stay informed through OPM updates, plan notices, and Open Season communications.

  • Contact a licensed agent listed on this website if you’re unsure about any step.

Staying Ahead of PSHB and Medicare Requirements

Understanding the relationship between PSHB and Medicare is more than just paperwork—it’s about ensuring access to the care you need when you need it. While 2025 introduces new rules, the fundamentals remain the same: you must actively manage your enrollment to secure your benefits.

If you’re nearing Medicare eligibility or assisting a family member who is, now is the time to verify your plan, understand the timelines, and ensure coordination is in place. A small oversight can lead to a year of denied claims or out-of-pocket surprises.

To protect your coverage and your peace of mind, get in touch with a licensed agent listed on this website for personalized help.