Key Takeaways

  • Your PSHB premium is only one part of what you spend on healthcare. Out-of-pocket costs like deductibles, copayments, and coinsurance can significantly increase your actual expenses.

  • Even if you rarely use your health plan, PSHB still carries annual financial responsibilities beyond the monthly premium, and these can add up quickly depending on your usage and life events.

The Real Price Tag Behind Your PSHB Coverage

If you’re enrolled in a Postal Service Health Benefits (PSHB) plan, you might think your biweekly premium deduction covers the majority of your healthcare costs. But the reality is far more complex. While your contributions are a predictable, recurring amount deducted from your paycheck, they are just the beginning of what you may spend throughout the year. The rest comes in forms you may not fully appreciate until a bill lands in your mailbox.

In 2025, you are responsible not just for premiums but also for a range of cost-sharing requirements. These include deductibles, copayments, coinsurance, and costs that may arise from using out-of-network providers or services not fully covered by your plan. All of these pieces contribute to the true cost of your PSHB plan.

Monthly Contributions: A Fixed but Incomplete Piece

Your monthly contribution is typically the most visible cost of your PSHB plan. For 2025, average annuitant monthly premiums range from about $241 for Self Only to over $567 for Self and Family plans. While these numbers are fixed and predictable, they often give a false sense of financial security.

Here’s what your monthly premium does cover:

  • Access to your chosen PSHB plan and network

  • A portion of routine preventive care

  • Eligibility for integrated Medicare Part D drug coverage if you’re Medicare-eligible

What it does not cover includes your share of most services. This is where the actual spending begins.

Annual Deductibles You Must Pay First

Before your plan begins paying its share for most services, you must meet an annual deductible. These vary widely depending on your plan type:

  • Low-deductible plans often have in-network deductibles ranging from $350 to $500.

  • High-deductible plans can require up to $2,000 in annual deductibles.

  • Out-of-network deductibles may go as high as $3,000 or more.

Until this deductible is met, you’re paying the full price for most services. This includes lab work, outpatient visits, minor procedures, and even prescriptions if your plan structures pharmacy benefits this way.

Copayments: Small Charges That Add Up Fast

Copayments are fixed-dollar amounts you pay for specific services. PSHB copays in 2025 generally range as follows:

  • $20 to $40 for primary care visits

  • $30 to $60 for specialist visits

  • $50 to $75 for urgent care visits

  • $100 to $150 for emergency room visits

On paper, these may seem minor, but they add up quickly when used repeatedly across a family or when seeing multiple providers in a short period. Ten specialist visits at $60 each? That’s $600 out of your pocket—and that’s before deductibles or coinsurance come into play.

Coinsurance: Your Share of the Bill

Coinsurance is the percentage of a medical bill you are responsible for after meeting your deductible. With PSHB plans in 2025, coinsurance typically ranges from:

  • 10% to 30% for in-network services

  • 40% to 50% for out-of-network services

For instance, a $5,000 outpatient procedure with 20% coinsurance means you pay $1,000 even after the deductible. And this assumes the provider is in-network. If they’re not, your share could double.

Out-of-Pocket Maximums: A Cap, But Not a Ceiling

Every PSHB plan includes an annual out-of-pocket maximum, which limits how much you have to pay for covered services in a given year. In 2025:

  • Self Only in-network maximums average around $7,500

  • Family coverage can reach up to $15,000

These caps provide important financial protection, but they only apply to covered, in-network services. They do not cover:

  • Out-of-network charges above plan allowances

  • Non-covered services

  • Premiums themselves

  • Any balance billing from non-participating providers

So while your plan may stop charging copays and coinsurance after you reach your maximum, it doesn’t mean the bills stop entirely.

Prescription Drug Costs: Separate, Yet Substantial

PSHB plans include drug coverage, and many coordinate with Medicare Part D for eligible annuitants. In 2025, the Part D benefit has undergone significant reform:

  • An annual out-of-pocket cap of $2,000 now applies

  • Cost-sharing varies by drug tier, with preferred generics costing less than non-preferred brand-name drugs

  • A new prescription payment option lets you spread high costs over 12 months

Even with these reforms, drug costs can take a sizable chunk of your healthcare budget, particularly if you or your dependents rely on multiple or high-cost medications.

Out-of-Network Surprises

Using out-of-network providers can severely increase your costs. Even if your plan offers out-of-network benefits, you’ll typically face:

  • Higher deductibles and coinsurance

  • The risk of balance billing

  • No maximum out-of-pocket protection on some charges

In areas with limited in-network providers—or during emergencies when you can’t choose—you may find yourself unexpectedly responsible for thousands more than you budgeted.

Extra Costs When You Delay Medicare Enrollment

If you’re eligible for Medicare but delay Part B enrollment, your PSHB plan may not coordinate benefits as favorably. For annuitants, failure to enroll in Part B when required can result in:

  • Increased cost-sharing

  • Loss of access to integrated drug benefits

  • Reduced overall plan benefits

In 2025, certain Medicare-eligible annuitants and family members must enroll in Part B to maintain full PSHB benefits. Not complying can result in coverage limitations.

Special Situations That Raise Your Healthcare Spending

Even with a solid plan, unexpected events can drive up costs:

  • Accidents and surgeries: Even with insurance, coinsurance and deductibles apply.

  • Chronic illnesses: Ongoing copays, medications, and therapy visits increase your monthly spending.

  • Maternity care: Though typically covered, costs can exceed thousands in cost-sharing.

  • Mental health and substance use treatment: Visits to specialists, therapy sessions, and inpatient care may involve separate benefit structures.

PSHB plans cover these services, but they rarely absorb all the financial responsibility.

Annual Planning Is Critical

Given all the variables—deductibles, coinsurance, copays, out-of-pocket limits—it’s critical to approach your PSHB coverage with a yearly financial plan. A good approach includes:

  • Estimating your household’s expected medical usage

  • Reviewing last year’s healthcare expenses

  • Understanding how each type of service will be billed

  • Factoring in worst-case scenarios against your plan’s out-of-pocket maximum

This approach helps avoid being caught off guard halfway through the year when your deductible resets or when unexpected costs arise.

The Real Cost of Not Understanding Your Plan

It’s easy to underestimate how much you’ll actually spend under PSHB in a given year. The premium may feel like the largest part because it’s the most visible. But once you tally up the deductible, coinsurance, copays, prescription drug expenses, and potential out-of-network care, the numbers tell a different story.

Failure to plan around these expenses can have lasting financial consequences, especially for retirees on fixed incomes. Overlooking these costs also risks delaying care due to affordability concerns, which can lead to even higher costs down the road.

Taking Control of Your Healthcare Spending

Understanding that your monthly contribution is only a fraction of your total PSHB-related spending puts you in a position to take control. Make use of:

  • Plan brochures for benefit specifics

  • Cost calculators to model expenses

  • Medicare coordination options to reduce redundant costs

  • Flexible Spending Accounts (FSAs) if you’re still actively employed

Small steps now can translate into big savings later.

What You’re Paying Beyond the Pay Stub

Your PSHB monthly contribution may seem like your biggest financial obligation, but the full cost of coverage runs much deeper. Deductibles, copayments, coinsurance, out-of-network charges, and prescription drug costs quietly add up over the course of a year—and sometimes, even a single incident can tip the scale.

To get clarity on what your actual exposure is and how you might reduce it, speak with a licensed agent listed on this website. They can help you understand your plan’s real structure and assist with Medicare coordination if you’re eligible.