Key Takeaways

  • If you are a Medicare-eligible Postal Service retiree or family member, failing to enroll in Medicare Part B in 2025 can result in a loss of PSHB coverage altogether.

  • Enrollment in Medicare Part B is now mandatory for many under PSHB rules, and delaying it could lead to penalties and gaps in health and drug coverage.

Understanding the 2025 Medicare Part B Requirement Under PSHB

As of 2025, the rules for Medicare-eligible Postal Service retirees and their families have changed significantly. With the implementation of the Postal Service Health Benefits (PSHB) Program, coordinated by the Office of Personnel Management (OPM), certain enrollees are now required to enroll in Medicare Part B to maintain their PSHB coverage.

This change is not optional for many. If you’re eligible for Medicare Part B and fall into one of the mandated groups, skipping enrollment can disqualify you from retaining or continuing PSHB coverage altogether. This article explains what this means for you, who is affected, what the timeline looks like, and how to avoid costly consequences.

Who Must Enroll in Medicare Part B for PSHB

You are required to enroll in Medicare Part B if you meet all of the following criteria:

  • You are enrolled or eligible to be enrolled in a PSHB plan.

  • You are a Postal Service retiree or an eligible family member.

  • You are entitled to Medicare Part A (typically premium-free).

  • You are age 65 or older, or otherwise eligible for Medicare due to disability.

Exceptions

Certain individuals are exempt from this mandate:

  • If you retired on or before January 1, 2025.

  • If you are an active Postal employee aged 64 or older as of January 1, 2025.

  • If you reside outside the United States and its territories.

  • If you are receiving benefits from the Department of Veterans Affairs (VA) or Indian Health Service (IHS) and meet exemption criteria.

If you do not fall under any of these exemption categories, Medicare Part B enrollment is no longer optional under PSHB.

What Happens If You Skip Part B

Choosing not to enroll in Medicare Part B when you’re required to can have immediate and long-term consequences:

  • Loss of PSHB Eligibility: You may be disenrolled from your PSHB plan or denied enrollment altogether.

  • Loss of Drug Coverage: Because PSHB plans integrate Part D drug benefits through an Employer Group Waiver Plan (EGWP), declining Part B can also impact your prescription coverage.

  • Permanent Late Enrollment Penalties: If you enroll later, you could pay a lifetime monthly penalty—10% of the premium for every 12-month period you delayed.

  • Coverage Gaps: Without Part B, services such as outpatient care, preventive services, and durable medical equipment might not be covered or may come with higher costs.

What the 2025 Timeline Looks Like

The Medicare Part B requirement under PSHB officially took effect on January 1, 2025. Here’s how the rollout unfolded:

  • Spring to Summer 2024: OPM provided a Special Enrollment Period (SEP) from April 1 to September 30, 2024, allowing eligible retirees and family members to enroll in Part B without penalty if they had previously declined it.

  • Fall 2024: During Open Season (November to December), enrollees had to confirm their Medicare status or risk losing eligibility.

  • January 1, 2025: The PSHB program officially launched, and Medicare-eligible individuals without Part B (who didn’t qualify for an exemption) became ineligible for PSHB coverage.

Why Medicare Part B Matters So Much Now

In previous years under the FEHB program, Medicare Part B was optional. Many retirees chose not to enroll because they felt their FEHB plan covered enough. That flexibility is gone under PSHB if you are subject to the new rules.

PSHB plans are built on Medicare coordination. Once you have both Medicare Parts A and B, your PSHB plan pays secondary. The benefits include:

  • Waived or reduced deductibles and copayments

  • Lower out-of-pocket costs for many services

  • Expanded access to doctors and providers who accept Medicare

  • Automatic enrollment in an enhanced Part D prescription drug plan

By declining Part B, you break this coordination. That’s why the PSHB rules are firm in requiring it for eligible individuals.

What Medicare Part B Covers in 2025

Medicare Part B includes:

  • Physician visits (both primary and specialists)

  • Preventive services (screenings, vaccines, wellness visits)

  • Outpatient procedures and surgeries

  • Lab tests and diagnostic imaging

  • Durable medical equipment (like walkers and oxygen)

  • Mental health outpatient services

2025 Costs

  • Standard Monthly Premium: $185

  • Annual Deductible: $257

  • Coinsurance: Typically 20% of Medicare-approved amounts after the deductible is met

Keep in mind that these costs are general and may vary slightly if you have higher income levels, triggering IRMAA (Income-Related Monthly Adjustment Amounts).

Drug Coverage Is Tied to Part B Enrollment

If you’re eligible for Medicare, PSHB plans automatically provide prescription coverage through Medicare Part D via an Employer Group Waiver Plan (EGWP). But this benefit assumes you are enrolled in both Parts A and B.

Declining Part B can mean:

  • You won’t be enrolled in the Medicare EGWP Part D plan.

  • Your PSHB drug coverage may be terminated or not begin at all.

  • You could face late enrollment penalties if you try to join Medicare Part D later.

PSHB plans aren’t required to provide standalone drug coverage outside of this framework. That’s why skipping Part B has a domino effect on your entire health and drug benefit package.

Can You Enroll in Part B Later?

Yes, but it may cost you.

If you didn’t take advantage of the SEP in 2024 and aren’t exempt, your next chance is during the General Enrollment Period (GEP) from January 1 to March 31, with coverage beginning July 1. However:

  • You may face late enrollment penalties—10% per 12-month delay.

  • You’ll have a coverage gap from January through June unless you have other qualifying coverage.

Delaying enrollment under the assumption that you can “always join later” is financially and medically risky.

How to Confirm You’re Compliant

Make sure you:

  • Have a copy of your Medicare card showing both Part A and Part B.

  • Check your status on Medicare.gov or by calling Social Security.

  • Notify your PSHB plan (or OPM) of your enrollment.

  • Keep documentation of any exemptions if applicable.

You should also confirm that your enrollment aligns with PSHB eligibility timelines and rules to avoid accidental disenrollment.

How PSHB Plans Work Once You Have Medicare

If you’re enrolled in both Medicare Parts A and B:

  • Medicare becomes your primary payer.

  • Your PSHB plan becomes secondary, paying remaining costs like copayments and coinsurance.

  • Most plans waive their deductibles and copays for Medicare-covered services.

  • You gain access to a broader provider network, including those who only accept Medicare.

  • You’re automatically enrolled in your PSHB plan’s Medicare Part D drug benefit through EGWP.

This setup can significantly reduce your out-of-pocket medical expenses, which is why maintaining both coverages is essential.

What If You’re Still Working Past 65?

If you’re still an active Postal Service employee after age 65, you’re not required to enroll in Part B until you retire. Your PSHB eligibility continues under employee rules, not retiree rules.

However, once you retire, you’ll be expected to enroll in Part B unless you meet an exemption. The timing of your retirement becomes critical to avoid penalties or coverage disruptions.

Final Thoughts on Protecting Your PSHB Coverage

PSHB has ushered in a new era of Medicare coordination. Enrolling in Medicare Part B is no longer a choice for many—it’s a requirement that directly impacts your ability to keep your health and drug benefits under PSHB.

If you’re unsure about your eligibility, exemption status, or enrollment deadlines, now is the time to act. Don’t assume you’re covered until you verify your Medicare enrollment aligns with PSHB requirements.

Get in touch with a licensed agent listed on this website who can review your individual situation and help you meet all necessary deadlines for 2025 and beyond.