Key Takeaways

  • Routine copays under PSHB plans can quietly accumulate into significant monthly and yearly expenses, especially if you see multiple specialists or require ongoing care.

  • Understanding how these copays work in tandem with deductibles, coinsurance, and out-of-pocket limits is essential to managing your healthcare spending.

What You Think You’re Paying vs. What You’re Actually Paying

Most people enrolled in Postal Service Health Benefits (PSHB) assume copayments are simple: a flat fee for each visit or service. While that’s technically accurate, what isn’t always obvious is how quickly those small payments can add up—particularly if you or a covered family member has ongoing health needs.

Let’s say you’re seeing a primary care doctor once a month, a specialist quarterly, and occasionally visiting urgent care. Even modest copays ranging from $20 to $75 per visit can quietly total several hundred dollars per month before you even realize it.

Routine Care Can Equal Frequent Copays

With PSHB plans, many common services require a copay. These include:

  • Primary care visits

  • Specialist consultations

  • Urgent care

  • Mental health therapy

  • Chiropractic or physical therapy sessions

  • Lab work and X-rays at certain facilities

While a single copay may seem manageable, the frequency of care drives the cost. A few visits per month for different types of care can easily double or triple your anticipated monthly healthcare spending.

Multiply by Dependents, and the Cost Spikes Further

If your spouse or child is also covered, copayments don’t just stack by type of visit—they multiply by family member. For example:

  • If your child needs regular therapy sessions

  • If your spouse sees a specialist every month

  • If everyone in your household visits urgent care during flu season

You’re no longer just paying for your own routine care. A family of three can face $200 to $500 in total monthly copays, depending on usage and plan structure.

How Copays Interact with Deductibles and Out-of-Pocket Maximums

Copayments are not always applied toward your deductible. In many PSHB plans:

  • Copays usually don’t reduce the deductible: They’re separate fees.

  • Copays may count toward the out-of-pocket maximum: But only after you’ve met the deductible.

  • You may still owe coinsurance even after paying a copay: For certain services or providers.

This layering means you could be paying a copay while also accumulating other medical expenses that don’t reduce your deductible, leaving you with more out-of-pocket costs than expected.

Preventive Services vs. Ongoing Care: Know the Difference

Many preventive services are fully covered under PSHB plans without any copayment. These include:

  • Annual physicals

  • Screenings like mammograms and colonoscopies

  • Immunizations

But the moment care shifts from preventive to diagnostic or therapeutic, copays kick in. For example:

  • A screening colonoscopy is usually free, but if a polyp is removed during the procedure, it may become diagnostic.

  • A free annual wellness visit may lead to follow-up appointments with specialist copays.

Understanding where the line is drawn helps you better anticipate copayment responsibilities.

Mental Health Copays Add Up Fast

Mental health is a critical component of care under PSHB, but it can also be one of the most frequent sources of copays. Weekly therapy or psychiatric check-ins can cost you $30 to $60 per session depending on the plan.

If you or a dependent is seeing a mental health provider every week, you’re looking at $120 to $240 per month in copays alone—potentially higher than what you pay for your monthly premium.

Prescription Copays: Another Layer of Routine Expense

In addition to provider visits, PSHB plans include prescription drug copays that vary by:

  • Generic vs. brand name drugs

  • Retail pharmacy vs. mail-order delivery

  • 30-day vs. 90-day supplies

Chronic conditions requiring multiple medications can result in monthly prescription copays reaching $100 to $300 or more. For high-cost specialty drugs, even tiered copay amounts can strain your budget over time.

Hidden Copays in Diagnostic Services

It’s easy to forget that diagnostic services like imaging, lab tests, or even outpatient procedures may come with separate copayments or coinsurance. For example:

  • Bloodwork may have a lab fee copay

  • Imaging such as MRIs or CT scans might require a higher-tier copay

  • Outpatient surgery could involve both a copay and additional facility charges

These charges often go unnoticed until the explanation of benefits (EOB) or bill arrives weeks later.

PSHB Plan Differences: Not All Copay Structures Are the Same

Your copay responsibility depends heavily on the specific PSHB plan you select. Factors influencing copay amounts include:

  • Plan type (high-deductible vs. low-deductible)

  • Network tier (in-network vs. out-of-network)

  • Service category (basic care vs. specialized services)

You may think you’re choosing a lower-cost plan, but higher copayments for routine care could result in more cumulative expenses than a plan with slightly higher premiums but lower copays.

Monthly Budgeting Should Account for Copay Accumulation

Most people budget their premium payments, but don’t build a separate line item for routine copayments. This can lead to:

  • Underestimating total healthcare costs

  • Unexpected credit card bills or account withdrawals

  • Difficulty forecasting expenses during open season

Create a monthly estimate of copays based on your average healthcare usage. Multiply:

  • Number of expected visits per month

  • Average copay per visit or service

  • Number of covered family members

This gives you a much clearer view of your actual monthly financial exposure.

When Copays May Temporarily Decrease

Some PSHB plans offer reduced copays:

  • After meeting the plan deductible

  • If you also have Medicare Part B and the plan coordinates benefits

  • For mail-order prescriptions vs. retail pickup

  • During certain wellness incentive periods or health programs

However, these reductions vary, and you must actively use or enroll in these programs to benefit. Relying on them as guaranteed savings can be risky if they change from year to year.

Year-End Totals Can Reach Thousands

If you calculate all copay-related spending for the year, you might find you’ve paid well over $2,000 to $4,000 out of pocket, especially in households with chronic conditions, ongoing therapy, or multiple dependents.

Add this to your premiums, and the real cost of healthcare becomes much more than just the plan’s monthly rate.

Timing Your Appointments Can Help Spread Costs

Strategically scheduling your care throughout the year—not clustering it all in the first few months—can help spread out your copayment expenses:

  • Schedule non-urgent specialist visits later in the year

  • Coordinate multiple services in a single visit to avoid repeated copays

  • Use telehealth options when available, which may have lower copays

This doesn’t reduce your copay obligations but can help with financial pacing.

Ask These Questions Before Scheduling Routine Care

To manage your expenses wisely, ask your provider or plan the following:

  • What will the copay be for this service?

  • Does this copay apply toward my deductible or out-of-pocket maximum?

  • Is there a more cost-effective setting to receive this care?

  • Will the provider be considered in-network?

  • Are telehealth visits cheaper for the same service?

Getting clarity before your appointment puts you in control of your financial expectations.

How PSHB Enrollees Can Better Manage Copay Costs

Here are a few strategies to reduce or manage the financial impact of copays under PSHB:

  • Track your medical spending monthly

  • Compare plans carefully during Open Season to evaluate not just premiums but also copays

  • Explore wellness programs or incentives your plan might offer for lower costs

  • Use preventive care fully to reduce the need for frequent follow-ups

  • Ask for generic medications when available

Being proactive can save hundreds to thousands over the course of a year.

Don’t Let Routine Copays Surprise You

The predictable nature of copays may seem comforting at first glance. But when used frequently, they’re anything but minor. In 2025, when medical inflation and cost-sharing continue to rise, every copay counts.

You owe it to yourself to take a more detailed look at how often you’re paying these fees and what alternatives your PSHB plan might offer. Adjusting how and when you seek care, and staying informed during each Open Season, can make a substantial difference.

To better understand your plan’s copayments and how they may affect your budget, reach out to a licensed agent listed on this website. A quick consultation could save you from unexpected expenses throughout the year.