Key Takeaways

  • Even with solid PSHB coverage, copayments can quietly accumulate into substantial annual costs.

  • Understanding when and how copayments apply helps you make more strategic decisions during Open Season and throughout the year.

PSHB Copayments: Small Charges with Big Potential Impact

You might look at your Postal Service Health Benefits (PSHB) plan and feel confident. Your premiums are manageable, the provider network is extensive, and your coverage appears strong. But the real surprise often lies in the fine print—the copayments. While these may seem minor at first glance, their impact becomes more noticeable as the months go by.

PSHB plans typically include copayments for:

  • Primary care and specialist visits

  • Urgent care and emergency room services

  • Prescription medications (tiered by generic, preferred brand, and specialty drugs)

  • Mental health counseling and telehealth services

  • Physical therapy and other rehabilitative services

Each of these interactions may only cost you a small amount out-of-pocket per visit or service. But in a single year, those numbers can snowball.

Understanding the Copayment Structure in 2025

In 2025, PSHB plans continue to follow a copayment structure based on service type and setting. Here’s a general overview of what to expect:

  • Primary Care Visit: Typically involves a fixed fee per visit, no matter the length or complexity.

  • Specialist Visit: A slightly higher fixed fee than primary care, reflecting specialist expertise.

  • Urgent Care: Set copayments apply, usually higher than a regular office visit.

  • Emergency Room: Often the highest copayment, regardless of treatment received.

  • Prescription Drugs: Split into tiers, with copays increasing significantly from generics to specialty medications.

These copayments apply each time you use the service. So while one visit may seem affordable, frequent use throughout the year can result in surprisingly high out-of-pocket costs.

Copayments vs. Coinsurance vs. Deductibles

It helps to distinguish copayments from other cost-sharing features like coinsurance and deductibles:

  • Copayment: A fixed amount you pay at the time of service. Predictable but frequent.

  • Coinsurance: A percentage of the cost of care, paid after meeting the deductible. Variable and can be larger.

  • Deductible: A set amount you must pay out-of-pocket each year before your plan starts covering costs.

While deductibles and coinsurance are often larger one-time or occasional expenses, copayments tend to be underestimated because they feel small—until you tally them up.

How Copayments Stack Up Over Time

To understand how copayments add up fast, consider the following monthly use pattern:

  • 2 primary care visits

  • 1 specialist visit

  • 2 generic prescriptions

  • 1 preferred brand-name prescription

  • 1 physical therapy session

Now multiply that by 12 months. Even if each copayment ranges between $20 and $60, the total can easily reach several thousand dollars annually, depending on your usage.

Many postal retirees and employees on a fixed income may not factor this in when budgeting for the year. The result? An unexpected shortfall or the need to cut back on needed care.

Copayments and Chronic Health Conditions

If you live with chronic conditions—like diabetes, heart disease, or arthritis—you’re likely to have more frequent visits to specialists, ongoing prescriptions, and routine lab work. Every interaction may carry its own copay, and the accumulation is even faster.

For instance:

  • Endocrinology appointments every 2–3 months

  • Lab work tied to medication monitoring

  • Physical therapy or pain management sessions

This pattern of care isn’t a matter of choice—it’s essential. That’s why understanding and planning for copayments is crucial, especially when choosing your PSHB plan.

Copayments in the Context of Family Coverage

If you’ve enrolled in a Self Plus One or Self and Family plan, copayments multiply with every covered member. Spouse and dependent healthcare needs often follow a separate rhythm of:

  • Pediatric checkups

  • Specialist visits for aging parents

  • Urgent care for children or young adults

What looks like a good plan based on premium alone may become one of your most expensive choices once recurring copayments are considered.

Copayments Under PSHB vs FEHB in the Past

Many postal workers have experience under the Federal Employees Health Benefits (FEHB) Program. In 2024 and prior years, certain plans under FEHB offered slightly different copayment ranges or waived copays under specific conditions. Now that PSHB is the mandatory system for USPS employees and retirees, it’s worth recalibrating expectations.

The PSHB transition that took effect in January 2025 emphasized medicare integration, but the role of copayments remains vital regardless of whether you’re Medicare-eligible. Even with waived deductibles or Medicare coordination, copays still appear on many service types.

Tips to Stay Ahead of Copayment Costs

Here’s how you can reduce surprises:

  • Track every copayment. Keep a simple log of each out-of-pocket visit and prescription.

  • Schedule strategically. If possible, consolidate appointments to reduce multiple copays in one week.

  • Review plan details annually. Open Season (November to December) is your chance to reassess your current plan.

  • Use telehealth when appropriate. Some PSHB plans charge lower copayments for virtual care.

  • Explore generic alternatives. For prescriptions, always ask if a generic version is available.

What PSHB Retirees Should Know About Medicare and Copayments

In 2025, many Medicare-eligible retirees are now integrated into Medicare Part B as part of the PSHB transition. While Medicare helps reduce the costs of many services, copayments are still present for:

  • Prescriptions under the Medicare Part D EGWP plan

  • Certain outpatient visits or services not fully covered

  • Services from providers outside of Medicare’s contracted network

So even with Medicare, copayments are a factor to consider. Medicare may soften the cost impact but not eliminate it.

Common Services with Recurring Copays in PSHB

  • Mental health sessions: Weekly or biweekly therapy adds up.

  • Vision and hearing services: While not always core services, they often carry separate copays.

  • Rehabilitative services: Recovery from surgery or injury means consistent copays for therapy.

  • Routine diagnostics: Imaging, lab work, and follow-up evaluations.

Many of these services are ongoing, not one-time, which increases their financial footprint across the year.

Don’t Let Copayments Catch You Off Guard

Many PSHB members pay close attention to premiums and deductibles during Open Season but overlook copayment accumulation. A plan that seems budget-friendly on the surface can cost significantly more across the year due to frequent copays.

Use every tool available to compare your total expected costs—not just your monthly premium. And if you’re unsure whether your copay-heavy plan is still your best option, it may be time to talk it through with a licensed insurance agent listed on this website.