Key Takeaways

  • While PSHB contributions may seem affordable at first glance, total costs can grow substantially once you account for deductibles, copayments, coinsurance, and prescription limits.

  • Understanding how each component of your PSHB plan affects your yearly healthcare spending is crucial for making cost-effective decisions during Open Season.

What Your Monthly Premium Doesn’t Tell You

When you look at your Postal Service Health Benefits (PSHB) plan premium, it’s easy to assume that number reflects your overall healthcare costs. After all, a manageable monthly payment is often what most people use to compare plans. But that’s only a portion of the full picture.

Premiums are only the beginning. In 2025, the PSHB monthly premiums paid by enrollees vary depending on coverage type—Self Only, Self Plus One, or Self and Family. While the government covers around 70% of the premium, your share is still a regular deduction from your retirement annuity or paycheck.

But premiums alone don’t determine how affordable your plan truly is. You also need to consider:

  • Annual deductibles

  • Copayments for services

  • Coinsurance for major medical events

  • Prescription drug coverage tiers

  • Out-of-pocket maximums

Many enrollees don’t calculate these hidden costs when choosing a plan, which can lead to costly surprises.

Deductibles Set the Stage for Annual Spending

In-network deductibles in PSHB plans typically range from $350 to $2,000, depending on whether you choose a standard or high-deductible health plan (HDHP). If your plan has a lower premium, it likely comes with a higher deductible.

This means you must first pay hundreds—sometimes thousands—of dollars before your benefits even kick in. For example:

  • A low-premium HDHP may have a $1,500 deductible.

  • A standard plan with a higher premium might offer a $500 deductible.

And out-of-network deductibles are often double or more.

While deductibles reset every calendar year, what you pay early in the year can influence your use of healthcare services throughout the year. Skipping preventive visits or deferring care to avoid hitting the deductible threshold can impact long-term health.

Copayments Add Up Faster Than You Think

Copayments are fixed fees you pay for covered services—like $30 for a primary care visit or $50 for a specialist. On their own, they may feel manageable. But multiply them across a family or a year of chronic care visits, and you’ll see how the total can become significant.

Here’s how copays typically play out:

  • Primary care visits: $20–$40 each

  • Specialist visits: $30–$60 each

  • Urgent care: $50–$75

  • Emergency room: $100–$150

Let’s say you see a specialist once a month and visit a primary doctor quarterly. That’s 16 visits a year. Even at the lower range, you could spend over $500 annually—on top of your premiums and deductible.

Copayments don’t count toward your deductible in most cases but do apply to your annual out-of-pocket maximum.

Coinsurance Is the Silent Budget Buster

Coinsurance is a percentage of the cost you must pay after meeting your deductible. For example, if your plan has 20% coinsurance for hospitalization, and your procedure costs $10,000, you owe $2,000.

This cost-sharing element is especially relevant for:

  • Hospital stays

  • Surgery and inpatient care

  • Specialty diagnostics and imaging

  • Physical therapy or rehab

Coinsurance percentages typically range from 10% to 30% for in-network services. Out-of-network costs are even higher—often 40% to 50%.

Unlike a flat copayment, coinsurance can vary wildly based on the service. You can’t always predict it, and that makes budgeting difficult.

Prescription Drug Tiers Can Catch You Off Guard

In 2025, PSHB plans include integrated Medicare Part D coverage for Medicare-eligible annuitants and family members. If you’re not Medicare-eligible, prescription drug coverage depends on your specific plan design.

Prescription coverage is often structured in tiers:

  • Tier 1: Generic drugs (lowest copay)

  • Tier 2: Preferred brand-name drugs (moderate copay)

  • Tier 3: Non-preferred brand-name (high copay)

  • Tier 4: Specialty medications (percentage-based coinsurance)

If you take specialty medications, your out-of-pocket costs can be substantial—often 25% to 33% of the drug’s price. Even with a Part D out-of-pocket cap of $2,000 in place for 2025, it’s easy to reach that limit quickly.

Many enrollees don’t factor in the full-year cost of their medications when evaluating a plan’s affordability.

Out-of-Pocket Maximums Aren’t Always the Safety Net You Expect

Every PSHB plan sets an out-of-pocket maximum for the year. For 2025, these caps generally range from:

  • $7,500 for Self Only (in-network)

  • $15,000 for Self Plus One and Self and Family (in-network)

Out-of-network limits can reach up to $20,000 or more.

These caps offer a financial ceiling, but hitting them means you’ve already spent thousands out-of-pocket. And these figures reset every January.

For retirees, these limits can significantly impact annual budgeting—especially if managing a chronic illness or preparing for elective surgery.

When Medicare Comes Into the Equation

For PSHB enrollees who are Medicare-eligible, enrolling in Medicare Part B is now required unless you qualify for an exemption. When you have both PSHB and Medicare, cost-sharing can shift considerably:

  • Lower copayments and coinsurance

  • Waived deductibles in some plans

  • Expanded provider networks

Some plans even offer partial reimbursement for Medicare Part B premiums, making dual enrollment financially advantageous.

However, if you don’t enroll in Medicare Part B when required, you could face:

  • Loss of drug coverage through PSHB

  • Limited provider access

  • Late enrollment penalties from Medicare

Understanding how PSHB and Medicare coordinate in 2025 is crucial to avoid gaps or duplicate costs.

Costs You Might Not Be Tracking Yet

Many PSHB enrollees overlook secondary costs that affect affordability:

  • Out-of-network claims: If you see a provider not in your plan’s network, your costs could double or triple.

  • Medical equipment: Coinsurance for durable medical equipment can be steep.

  • Mental health visits: May have different cost structures or separate visit limits.

  • Rehabilitation services: Often come with coinsurance and session limits.

Also consider your life stage: a retiree managing chronic conditions will face very different costs than a healthy postal worker in their 30s.

How to Approach Open Season Differently This Year

From November to December each year, you get the chance to evaluate and change your PSHB plan. Before you do:

  • Calculate your total healthcare spending from the past year

  • Add up premiums, deductibles, copays, and prescription costs

  • Compare plan brochures side-by-side—not just monthly premiums

  • Look for plans that integrate well with Medicare if you’re eligible

  • Call a licensed agent listed on this website to walk through your options

Being strategic during Open Season is the most powerful way to control your healthcare costs.

Why It Pays to Think Beyond the Monthly Premium

What looks affordable on paper might not stay that way in practice. Premiums are only a sliver of the real cost. Deductibles, copayments, coinsurance, and medication costs all add up—and usually faster than you expect.

If you’re retired or on a fixed income, the financial impact can be even more noticeable. And if you’ve never hit your out-of-pocket maximum, that doesn’t mean you won’t someday.

Take the time to break it all down this year. Don’t just ask “What’s my monthly cost?” Ask: “What’s my real annual cost—including everything?”

Start Your Plan Review with the Full Picture

By understanding the layered costs within your PSHB plan, you put yourself in a stronger position to choose wisely. Especially in 2025, when new Medicare rules and prescription caps are influencing plan design, it’s essential to compare more than just premiums.

If you’re unsure where to begin, speak with a licensed agent listed on this website. They can help you review all aspects of your plan—including how Medicare fits in, and what you’re really paying over the year.