PSHB Deductibles Are Structured Differently—Here’s How They Can Catch You Off Guard

Key Takeaways

• PSHB deductibles in 2025 operate under unique structures that can reset or vary by service category, family tier, or even coordination with Medicare.

• Misunderstanding how and when your deductible applies may lead to higher-than-expected out-of-pocket costs, especially early in the year.

What Makes PSHB Deductibles Different in 2025

Under the Postal Service Health Benefits (PSHB) Program, deductibles aren’t always straightforward. Unlike some legacy FEHB plans or commercial coverage you may have had in the past, PSHB deductibles in 2025 can be tiered, split by network type, and even affected by Medicare enrollment. This structure allows for flexibility, but it also introduces complexity.

Here’s what you need to be aware of as you evaluate your PSHB plan options and prepare for potential costs.

Network vs. Out-of-Network Deductibles

Nearly all PSHB plans differentiate between in-network and out-of-network services. Each of these may have separate deductibles:

• In-network deductibles are usually lower and apply to services received from providers contracted with the plan.

• Out-of-network deductibles are generally higher and kick in when you receive care from non-participating providers.

You need to track these separately, as paying off your in-network deductible won’t reduce your out-of-network deductible, and vice versa.

What This Means for You

If you assume all your care will be in-network but then receive an out-of-network bill unexpectedly—perhaps from a specialist or lab not listed—you may face a second, higher deductible you weren’t planning on.

Deductibles Can Be Individual or Family-Based

Each PSHB plan lists deductible amounts for both individual and family tiers. But here’s the catch—family deductibles may not work the way you expect.

• In some plans, the family deductible only kicks in once all members collectively reach a certain amount.

• Other plans apply an embedded structure, where each individual must meet a smaller, separate deductible before the family maximum applies.

Why This Catches People Off Guard

If you’re enrolled in a Self Plus One or Self and Family plan, it’s crucial to understand if your plan has an embedded deductible or not. Without that knowledge, you could think you’ve met the deductible, only to find out your family member hasn’t—or vice versa.

Not All Services Count Toward Your Deductible

It’s a common misconception that every dollar you spend on healthcare counts toward your deductible. In PSHB plans, this isn’t always the case.

Common Exclusions

• Copayments for services like office visits may not count.

• Prescription drugs might have a separate deductible altogether.

• Preventive services usually bypass the deductible but still appear on your plan summary, adding confusion.

Always read your plan brochure to confirm what counts. Don’t assume your copays or pharmacy costs help you chip away at the deductible.

Medicare Can Reset or Eliminate Your Deductible

If you’re Medicare-eligible and enrolled in both Medicare Part B and a PSHB plan, many PSHB plans will waive or significantly reduce your deductible. But there’s a timing and structure element to this.

Key Timing Considerations

• If you turn 65 mid-year and enroll in Medicare Part B, your deductible might reset based on the new coordination rules.

• Some plans calculate a pro-rated deductible once Medicare is in effect, while others apply a full reset.

Bottom Line

A deductible that was nearly met before Medicare enrollment could be lost entirely after coordination begins. That means you might have to start over unless the plan specifically prevents this.

High-Deductible Health Plans (HDHPs) Add Another Layer

Several PSHB plans are classified as high-deductible health plans (HDHPs), which come with their own rules:

• HDHPs must follow IRS minimums: for 2025, that’s $1,650 for individual coverage and $3,300 for family coverage.

• These plans are paired with Health Savings Accounts (HSAs), which add value but also require meeting the full deductible before most cost-sharing begins.

You should weigh the benefits of an HSA against the risk of facing large up-front costs early in the year.

The Calendar Year Rule Isn’t Always Clear-Cut

Deductibles are calculated on a calendar year basis—January 1 through December 31. However, if you change your PSHB plan during Open Season, or have a qualifying life event (QLE), the deductible structure may shift unexpectedly.

Scenarios to Watch For

• Changing plans mid-year due to a QLE? Your deductible resets, even if you’ve met it under the previous plan.

• Switching from a high-deductible to a low-deductible plan? You’ll start from zero in the new structure.

In short, switching plans resets your deductible in nearly all cases.

Pharmacy Deductibles Can Be Hidden in the Fine Print

Some PSHB plans offer separate pharmacy benefits through a Medicare Part D EGWP (Employer Group Waiver Plan). These can include separate drug deductibles or coinsurance tiers that you don’t see in the main plan summary.

What to Look For

• Check for a line item labeled ‘Prescription Drug Deductible’.

• Confirm if that deductible resets on January 1 or based on your Medicare status.

• Understand whether it applies to both brand and generic drugs.

These details are critical if you rely on high-cost medications. A drug deductible on top of your medical deductible can double your expected out-of-pocket cost early in the year.

Embedded vs. Aggregate Deductibles: Know the Structure

In 2025, PSHB plans often follow either an embedded or aggregate deductible model. Knowing the difference matters.

• Embedded deductibles allow each person to meet their individual limit, even in family coverage.

• Aggregate deductibles require the entire family to reach the combined deductible before any benefits kick in.

Why This Matters

Under an aggregate model, a single high-cost claim from one family member won’t trigger coverage unless the total family deductible is met. With embedded deductibles, that same claim could trigger coverage sooner for the individual.

How to Track Your Deductible Accurately

Most PSHB plans now offer digital portals where you can view your deductible progress. But the information may lag behind recent claims.

Best Practices

• Log in to your plan portal monthly.

• Cross-check any Explanation of Benefits (EOBs) with the deductible tracker.

• Don’t assume that a bill marked “you owe” reflects only your cost after the deductible—it might still include unmet deductible amounts.

Let’s Summarize Why PSHB Deductibles Deserve Your Attention

The PSHB deductible structure in 2025 can catch you off guard in multiple ways—from mid-year resets to uncounted services and unexpected tiers. A deductible is no longer just a number; it’s a set of rules and exceptions that can directly affect your healthcare expenses and timing of coverage.

To protect yourself:

• Read the full deductible section in your PSHB plan brochure.

• Pay attention to embedded vs. aggregate structures.

• Confirm how your deductible interacts with Medicare.

If you’re unsure how your plan works—or whether a different PSHB plan might reduce your risk of surprise costs—get in touch with a licensed agent listed on this website for help selecting the right plan for your needs.