Before PSHB Starts Covering You, These Deductibles Can Sting

Key Takeaways

• Even with strong coverage, your PSHB benefits don’t start paying until you’ve met the annual deductible—these out-of-pocket costs can come as a surprise.

• Deductibles vary widely across plans, and they apply before coinsurance or copayments kick in, making it crucial to budget for them at the start of the year.

The First Costs You Face: Understanding the PSHB Deductible

If you’re enrolled in a Postal Service Health Benefits (PSHB) plan for 2025, it’s important to realize that coverage doesn’t begin the moment you step into a doctor’s office. Before your plan pays a single dollar for most covered services, you need to meet your deductible. And depending on your plan choice, that could mean hundreds—or even thousands—of dollars out of your own pocket first.

Deductibles are the silent gatekeepers of your coverage. They can sting especially hard early in the year or after a health event. So, what should you expect, and how can you plan?

What the Deductible Means in 2025

In 2025, PSHB deductibles function similarly to those in other employer-based health insurance plans:

• You must pay the full cost of most covered services until you meet your plan’s deductible.

• After meeting the deductible, your plan begins to share costs through coinsurance or copayments.

This setup applies to services like:

• Specialist visits

• Outpatient surgery

• Diagnostic tests (like MRIs or CT scans)

• Emergency care

Preventive services are typically not subject to the deductible, but it’s essential to check your plan brochure to see what’s excluded.

How Much Are You Likely to Pay?

In 2025, PSHB plans offer a range of deductible structures. Most low-deductible options have annual deductibles between $350 and $600 for Self Only coverage. For Self Plus One or Self and Family, that amount may double or even triple.

High-deductible health plans (HDHPs), which are designed to pair with Health Savings Accounts (HSAs), often start with deductibles of $1,500 for Self Only and $3,000 or more for families.

These figures are for in-network services. If you go out of network, deductibles can be significantly higher—often two to three times more.

Why the Deductible Often Feels Like a Surprise

It’s easy to forget about the deductible when you’re healthy or not using many services. But if you need care early in the year or after a sudden illness, the upfront cost can be jarring.

Many postal retirees and employees are surprised to see a bill for a few hundred dollars after an office visit, simply because they haven’t met their deductible yet.

Key reasons the deductible catches people off guard:

• It resets every January. Even if you met your deductible in December 2024, you start over in January 2025.

• It applies before coinsurance. You pay the full cost of covered services until the deductible is met.

• It’s higher out-of-network. Using out-of-network providers usually means much higher deductibles.

Timing Matters: When and How You Hit the Deductible

The deductible is tracked on a calendar-year basis, which means you have from January 1 to December 31 to meet it. Your payments toward the deductible accumulate during this time, based on:

• Invoices from in-network providers

• Out-of-pocket payments for covered services

• Prescription costs if your plan counts them toward the deductible

Once the total reaches the plan’s deductible amount, cost-sharing begins. But it’s important to understand:

• Not all services count toward the deductible (e.g., cosmetic procedures, non-covered medications)

• Not all costs apply if you use out-of-network providers (unless your plan allows it)

Comparing Deductibles: Why It’s Worth the Time

During the Open Season period from November to December, you’re able to review and switch your PSHB plan. This is your opportunity to compare deductibles side by side.

Things to consider when comparing deductibles:

• How often you use care. If you need regular treatment, a lower deductible may be more cost-effective.

• Your emergency fund. Can you afford a $1,500 or $3,000 hit early in the year?

• Your Medicare status. If you’re Medicare-eligible and enrolled in Part B, some PSHB plans coordinate benefits and may waive or reduce deductibles.

Strategies to Handle Your Deductible Proactively

Rather than waiting to be surprised by your deductible, consider these approaches:

• Budget for it. Treat your deductible like a fixed cost. Set aside funds in January to cover it.

• Use an FSA or HSA. Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) allow you to pay deductibles with tax-advantaged dollars.

• Schedule care wisely. If you know you’ll need care, consider grouping services in the same calendar year to meet your deductible sooner and benefit from cost-sharing afterward.

• Check coordination with Medicare. If you’re over 65 and enrolled in Medicare Part B, verify if your PSHB plan waives the deductible.

Medicare’s Role in PSHB Deductibles

If you’re Medicare-eligible in 2025 and enrolled in Part B, many PSHB plans reduce or eliminate deductibles for covered services. This is especially true for retirees who retired before January 1, 2025, or who fall under one of the PSHB exemptions.

Coordination with Medicare can result in:

• Lower out-of-pocket costs

• Waived or reduced deductibles

• Enhanced pharmacy benefits (through the EGWP Part D integration)

That said, not all plans offer these perks. Make sure to read the plan brochure or speak with a licensed insurance agent listed on this website to confirm.

Out-of-Pocket Maximums: Your Safety Net

Even if your deductible is high, there’s a limit to how much you’ll pay out of pocket annually. This is known as the out-of-pocket maximum. In 2025:

• In-network caps range from $5,000 to $7,500 for Self Only coverage

• Family coverage can have limits up to $15,000 or more

Once you’ve paid enough to hit this cap—through deductibles, copayments, and coinsurance—your plan covers all remaining in-network expenses for the year.

Out-of-network expenses may not count toward this limit, so staying in network is often financially safer.

Your Deductible Decisions Start Now

As a postal employee or retiree, your health plan decision has a big impact on your finances—especially when it comes to deductibles. These costs are front-loaded and unavoidable unless you only use preventive care.

Take time to:

• Review plan brochures carefully

• Consider how frequently you use medical services

• Check how your PSHB plan coordinates with Medicare if eligible

And if you’re not sure what your deductible is—or how to compare it with other options—it’s time to ask.

Don’t Let Deductibles Derail Your Plan

Deductibles are a predictable part of your annual healthcare expenses, but they’re often overlooked. By understanding how they work under PSHB in 2025, you can make smarter choices about your coverage and budget.

If you still have questions, reach out to a licensed insurance agent listed on this website. They can walk you through your plan’s deductible structure and help you compare options during Open Season.