Key Takeaways

  • You must meet specific criteria to be eligible for the Postal Service Health Benefits (PSHB) Program in 2025—don’t assume your coverage is automatic.

  • Knowing your employment or retirement status and understanding Medicare coordination rules will help you avoid surprise gaps in your health coverage.

Why Eligibility Isn’t Automatic in 2025

Just because you’ve been enrolled in FEHB for years doesn’t mean you’re automatically set for PSHB. Starting in 2025, the new Postal Service Health Benefits program replaces FEHB coverage for Postal Service employees and retirees—but enrollment rules have changed.

If you’re currently an employee or already retired from USPS, you still need to meet certain eligibility and enrollment steps to continue your coverage under PSHB. Not checking the right boxes could mean you lose your benefits—or pay more than you should.

Who Needs to Pay Attention?

The transition to PSHB affects several categories of people:

Each group has different requirements and considerations. Let’s break them down.

USPS Employees

If you’re a USPS employee in 2025, you are required to enroll in a PSHB plan during the Open Season unless you’re already covered under a family member’s plan. While your eligibility is generally guaranteed, you must take action if you want a specific plan.

Key points for employees:

  • Automatic enrollment may occur based on your FEHB plan, but reviewing your options is important.

  • Changes can be made during the Open Season (typically November through December).

  • If you’re nearing retirement, your choices now will impact future benefits.

Postal Retirees

If you’re already retired, you’re still eligible for PSHB—but that doesn’t mean you’re automatically enrolled in the right plan. You’ll likely be transitioned into a corresponding PSHB plan unless you actively make a different selection.

Here’s what to keep in mind as a retiree:

  • Automatic enrollment doesn’t always mean the best fit for your health needs.

  • If you’re eligible for Medicare, coordination with Part B is crucial.

  • You must review the plan you’re assigned and compare options during Open Season.

Covered Family Members

If your spouse, child, or other eligible dependent is covered under your USPS plan, they’re part of this transition, too. Their eligibility for PSHB hinges on your eligibility, and you’re responsible for making sure they’re included when you enroll.

  • Children must meet age and dependency requirements.

  • Spouses must be legally recognized and listed on your enrollment.

  • Ex-spouses are not eligible for PSHB unless a court order specifically mandates continued coverage.

Timing Is Everything

The timing of your enrollment can affect your benefits, costs, and even your ability to get coverage at all. USPS and OPM coordinate to offer a special Open Season period in the last two months of the year—typically November and December.

Mark your calendar for Open Season:

  • You must enroll or make changes during this period unless you experience a Qualifying Life Event (QLE).

  • If you miss it, you may have to wait until the next year unless you qualify for a Special Enrollment Period.

  • Retirees who don’t respond during Open Season will be auto-enrolled in a similar PSHB plan, but that plan might not be ideal for your current health status.

Medicare and PSHB: What You Should Know

Starting in 2025, coordination between PSHB and Medicare is more important than ever. If you’re Medicare-eligible, you’ll be required to enroll in Medicare Part B to maintain full PSHB benefits—unless you meet certain exceptions.

Who’s required to enroll in Medicare Part B for PSHB:

  • If you retired after January 1, 2025, and are eligible for Medicare

  • If you’re turning 65 this year and not already enrolled

  • If you’re a family member covered under a retiree’s plan and you qualify for Medicare

Exceptions apply if:

  • You retired on or before January 1, 2025 and aren’t enrolled in Part B

  • You’re covered under a working family member’s group health plan

Failing to enroll in Medicare Part B when required could reduce your PSHB benefits or even cancel them.

Avoiding Common Mistakes

There are a few missteps that could easily result in gaps in your coverage—or cost you more than necessary.

1. Assuming You’re Automatically Covered

Many employees and retirees believe their transition into PSHB will just happen in the background. While that might be partially true, your plan selection may not suit your current health or financial needs. Always double-check your enrollment.

2. Ignoring the Medicare Requirement

If you’re 65 or older—or will be soon—you need to understand how Medicare Part B enrollment ties into PSHB eligibility. It’s not optional if you want the full benefits PSHB can offer.

3. Overlooking Family Eligibility

If you have family members on your current plan, verify that they still qualify under PSHB and are included in your new enrollment. This includes spouses, children, and even survivor annuitants.

4. Missing Open Season Deadlines

Even if you’re automatically enrolled in a plan, you’ll miss out on better options or benefits if you ignore Open Season. Mark your calendar and explore your options while you can still make changes.

What Happens if You Don’t Enroll?

If you ignore Open Season and fail to make a selection, USPS and OPM will automatically enroll you in a similar PSHB plan. While this ensures continuity of coverage, it may not:

  • Be the most affordable option

  • Include all the benefits you need

  • Cover your preferred providers

Even worse, if you don’t meet Medicare requirements and fail to enroll in Part B when required, you may face:

  • Reduced benefits

  • Denied claims

  • Potential disenrollment from PSHB

Special Enrollment Periods (SEP)

If you miss Open Season, you may still be able to enroll or change plans during a Special Enrollment Period, but you need a qualifying event. Common QLEs include:

  • Marriage or divorce

  • Birth or adoption of a child

  • Loss of other coverage

  • Moving to a new service area

SEPs are time-limited, typically 30 to 60 days from the event, so don’t delay.

Survivor Benefits and PSHB

If you’re a surviving spouse or family member of a USPS retiree, you may still qualify for PSHB coverage—but only if the deceased retiree elected survivor benefits under their annuity.

Things to know as a survivor:

  • Your eligibility depends on the retiree’s elections at retirement.

  • You must continue to receive a survivor annuity.

  • You must enroll in PSHB during Open Season or a QLE.

If these conditions aren’t met, PSHB coverage will not continue.

Staying Informed Going Forward

The PSHB program is new, and changes are still being phased in. USPS and OPM will continue providing information, but don’t rely on automatic updates alone.

Here’s what you should do to stay in the loop:

  • Check your mail and email regularly for updates from OPM or USPS.

  • Visit the official benefits portal during Open Season.

  • Keep your address and contact info current with HR or shared services.

  • Review your annuity and Medicare status yearly.

Lock In Your Coverage With Confidence

Securing your PSHB eligibility isn’t a one-and-done deal—you need to stay engaged, especially during Open Season and life transitions. Whether you’re still working or fully retired, taking the time to understand eligibility rules and Medicare coordination will keep you covered without hiccups.

If you’re unsure about your specific eligibility or what plan is best for you, it’s worth getting help. Speak with a licensed agent listed on this website for expert advice tailored to your situation.