Key Takeaways

  • A deductible that appears affordable on paper can lead to higher-than-expected out-of-pocket costs depending on how and when you use your PSHB benefits.

  • Factors such as multiple provider visits, pharmacy needs, and out-of-network care can drastically affect how quickly you hit your deductible and what you pay afterward.

Why the Deductible Looks Manageable

On the surface, the deductible listed in your Postal Service Health Benefits (PSHB) plan may seem modest. In 2025, many PSHB plans present deductibles in the range of $350 to $500 for in-network services. Compared to high-deductible health plans in the private market, this may appear like a good deal.

But the reality is more complex. Your actual costs depend not just on the deductible amount itself but also on:

  • The frequency and type of services you use

  • How much of the care is subject to the deductible

  • Whether you’re using in-network or out-of-network providers

  • What happens after the deductible is met

You Don’t Pay the Deductible All at Once

Many PSHB enrollees assume the deductible is a single upfront payment. It isn’t. Instead, it accumulates over time as you receive covered care that’s subject to the deductible. This structure can lead to confusion because you might:

  • Underestimate how often you’ll need care in a given year

  • Think copayments cover everything when they don’t count toward your deductible

  • Assume your plan begins covering all costs right after you pay for your first few appointments

In reality, only certain types of care apply toward the deductible. Lab work, imaging, specialist visits, and non-preventive services typically count. But primary care visits with a copay may not.

Timing Plays a Bigger Role Than You Think

The calendar year deductible resets every January. So if you seek care in December and again in February, you could face the full deductible in both instances.

This is especially important if:

  • You or a family member have a chronic condition requiring regular attention

  • You delay care until the end of the year thinking you’ve met the deductible

  • Your care crosses into a new calendar year

Even within a single year, timing can impact how quickly you accumulate charges toward your deductible. A string of services within a short time span could mean you hit your deductible faster, but also face a flurry of costs upfront.

Not Everything Applies to the Deductible

It’s easy to assume that all your health expenses count toward your deductible, but that’s not how PSHB plans work. Typically, you pay:

  • Copayments for office visits and prescriptions

  • Coinsurance for procedures or hospitalizations after the deductible is met

However, your copayments generally do not apply to your deductible. Neither do premiums. This can result in the following issues:

  • You pay hundreds in copays without progressing toward your deductible

  • You reach a misleading sense of how much you’ve already “paid into” the plan

  • You still owe the full deductible when you finally need more expensive care

Family Plans Add Another Layer

If you’re enrolled in a Self Plus One or Self and Family plan, your deductible situation becomes even more layered. In many PSHB plans:

  • Each family member must meet an individual deductible (e.g., $500)

  • The family must collectively meet a higher threshold (e.g., $1,000 to $1,500) before the plan covers everyone’s care at the coinsurance level

This creates a situation where:

  • One family member could meet their individual deductible but still be subject to copays and coinsurance until the family deductible is met

  • Multiple moderate-cost visits across family members fail to satisfy either deductible fully

Coinsurance Kicks In, Not Full Coverage

Reaching your deductible doesn’t mean the plan pays 100% of your costs. After meeting the deductible, you typically move into the coinsurance phase. Under PSHB, coinsurance often means:

  • Paying 10% to 30% of in-network service costs

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

These percentages can result in sizable bills, especially for:

  • Imaging tests like MRIs or CT scans

  • Outpatient surgeries

  • Emergency room visits

You remain in this cost-sharing phase until you reach your plan’s out-of-pocket maximum, which in 2025 typically ranges from $7,500 for Self Only plans to $15,000 for family plans.

Out-of-Network Care Can Derail Expectations

Even if your deductible seems reasonable for in-network care, the numbers can balloon if you go out-of-network. You could be charged:

  • A higher deductible for out-of-network services, often $1,000 to $3,000

  • Higher coinsurance percentages

  • Balance billing amounts not covered by your plan at all

This can happen unintentionally, such as:

  • A lab facility processing your test being out-of-network

  • A specialist within a hospital not being part of your plan’s provider network

  • Emergency care routed to the nearest facility, which may be out-of-network

The result? You pay significantly more, and those costs may not apply to your in-network deductible or out-of-pocket max.

Preventive Care Isn’t the Safety Net You Assume

While most PSHB plans cover preventive services at no cost to you (e.g., wellness visits, screenings), this coverage doesn’t help you meet your deductible. That’s because:

  • These services are excluded from the deductible

  • They don’t contribute toward your out-of-pocket max either

So if you’ve only used preventive care all year and then need diagnostic services or surgery, you’re starting at zero when it comes to the deductible.

Pharmacy Benefits Are Often Separated

Prescription costs in many PSHB plans are managed separately from medical expenses. You may have:

  • A separate drug deductible

  • Tiered copayments for generic, brand, and specialty drugs

  • A separate out-of-pocket maximum

This division means you could:

  • Hit your deductible for medical care but still owe high pharmacy costs

  • Pay out-of-pocket for prescriptions that don’t count toward your medical deductible

  • Face different cost structures for retail and mail-order drugs

The Out-of-Pocket Max: Rarely Reached But Critical

PSHB plans do offer financial protection in the form of an annual out-of-pocket maximum. For 2025, that’s $7,500 for individuals and $15,000 for families using in-network care.

Once this limit is reached:

  • The plan covers 100% of remaining eligible in-network costs

  • You pay nothing more for covered services in that calendar year

However, most enrollees never hit this ceiling unless they experience a major health event. That means:

  • You remain in the deductible and coinsurance phases for most of the year

  • You may not experience the “full coverage” benefit you expected

  • You still face uncertainty in your healthcare costs month to month

Strategic Use of Care Can Help

To avoid unexpected financial stress, you should approach care strategically:

  • Stay in-network: Verify each provider and facility beforehand

  • Schedule care earlier in the year: Especially if you anticipate ongoing treatment

  • Track your deductible progress: Use your plan’s member portal

  • Bundle services when possible: Getting multiple procedures at once may be more cost-efficient

  • Ask about estimated costs: Providers often offer tools or estimates in advance

Understand Before You Commit

Reviewing the Summary of Benefits and Coverage (SBC) before enrolling or during Open Season is vital. Pay attention to:

  • Which services are subject to the deductible

  • Whether copays count toward the deductible

  • How your plan handles out-of-network care

  • Differences between Self Only and Family structures

Understanding these distinctions helps you prepare—not just for premiums, but for what you’ll realistically pay throughout the year.

Don’t Rely on a Single Number

The deductible is just one part of a much bigger picture. You must also weigh:

  • Coinsurance rates

  • Copayment amounts

  • Prescription drug costs

  • The likelihood of using out-of-network providers

All of these elements combine to determine what your healthcare will actually cost in 2025.

What You Can Do Right Now

If you’re already enrolled in a PSHB plan:

  • Review your Explanation of Benefits (EOBs) regularly

  • Log into your health plan account to monitor deductible usage

  • Ask your provider’s office to confirm if services are subject to the deductible

If you’re considering switching plans during Open Season:

  • Request side-by-side comparisons

  • Talk to a licensed agent listed on this website to help break down your total cost exposure

How to Plan Smarter for 2025

If you want more predictable costs, consider:

  • Choosing a plan with a lower deductible and slightly higher premium

  • Factoring in not just the deductible, but coinsurance, copays, and prescription tiers

  • Assessing your family’s expected use of care across the full year

Planning around the deductible—rather than just accepting it at face value—can prevent financial surprises.

Understanding the True Impact of Your Deductible

The deductible in your PSHB plan might look harmless, but it often carries more weight than it first appears. It doesn’t operate in isolation, and it rarely covers all that you assume it does. By staying informed, tracking your actual costs, and seeking help when needed, you can make better decisions throughout the year.

If you’re unsure how your deductible fits into your overall PSHB plan structure, it’s smart to speak with a licensed agent listed on this website who can guide you based on your situation.