Key Takeaways

  • While many PSHB plans advertise low in-network deductibles, certain services or settings may trigger much higher out-of-pocket costs than you expect.

  • Failing to read your plan brochure in full—especially the exceptions and footnotes tied to deductibles—can lead to unexpected bills, especially for out-of-network care, specialty services, or tiered plan structures.

Don’t Rely on the Deductible Summary Page Alone

When reviewing a Postal Service Health Benefits (PSHB) plan, it’s easy to focus on the summary page that features key numbers: monthly premium, deductible, copayment, and out-of-pocket maximum. But if you assume the deductible applies universally across services and providers, you may be overlooking critical exceptions that can significantly increase your costs.

The deductible listed for in-network care is often straightforward. But PSHB plans commonly layer in additional or alternate deductibles depending on the care type, facility, or service tier. These are not always highlighted in summaries and may only be clarified several pages into the brochure.

What the Brochure Really Says

Each PSHB plan is required to publish a brochure through the U.S. Office of Personnel Management (OPM). These brochures are structured but dense. While they follow a common format, the small print and footnotes often hide clauses that adjust deductibles based on:

  • Whether the service is received in-network or out-of-network

  • The type of service (e.g., mental health, physical therapy, durable medical equipment)

  • Whether the plan uses tiered provider networks

  • If the service is subject to a separate deductible

For example, a plan may advertise a $500 in-network deductible. But tucked away in a different section, you may find that:

  • Out-of-network care has a $2,000 deductible

  • Specialty mental health services have their own $1,000 deductible

  • Durable medical equipment isn’t covered until a separate deductible is met

If you don’t dig deep into these details, you might falsely believe the single low deductible applies to all situations.

Out-of-Network Surprises

Many PSHB enrollees use out-of-network providers at some point during the year, especially if they travel, relocate, or get referred to a specialist. Unfortunately, this is one of the most common areas where people misunderstand how deductibles shift.

In 2025, most PSHB plans have a substantially higher deductible for out-of-network care—often between $1,000 and $3,000. Even if your in-network deductible is low, your plan might not pay anything toward out-of-network claims until that higher figure is met. This can lead to costly surprises if:

  • You’re admitted to an out-of-network hospital

  • You receive diagnostic tests at an out-of-network lab

  • Your provider refers you to a specialist outside the plan’s network

Always look at the plan’s “Summary of Benefits by Category” to compare the deductibles side-by-side for in-network and out-of-network scenarios.

Special Services with Separate Deductibles

Not all healthcare services fall under the standard deductible. In 2025, several PSHB plans apply distinct deductible rules to certain categories of care. These exceptions usually apply to:

  • Chiropractic care

  • Physical or occupational therapy

  • Behavioral health or substance use services

  • Home health or hospice care

  • Prosthetic devices or durable medical equipment

In some cases, these services don’t count toward your general deductible at all. Instead, they may require their own smaller (or larger) deductible that resets annually. This means you may pay the full cost of those services even after you’ve already met your plan’s main deductible for the year.

High-Deductible Health Plans (HDHPs) and Confusing Limits

A number of PSHB options are designated as High-Deductible Health Plans (HDHPs). These are typically paired with a Health Savings Account (HSA) and feature:

  • Deductibles starting at $1,650 (Self Only) or $3,300 (Family) in 2025

  • Out-of-pocket maximums that can exceed $8,000

However, many enrollees assume the HDHP deductible is a single number. In practice, some HDHPs enforce an embedded deductible structure—meaning each family member must meet a certain portion of the family deductible before coverage kicks in for that individual.

Also, for HDHPs, every covered cost (except preventive services) counts toward the deductible. That includes:

  • Prescription drugs

  • Imaging (MRI, CT scans, etc.)

  • Specialist visits

  • Emergency services

This structure differs from traditional plans that often apply copayments immediately for doctor visits or medications.

Split-Year Deductibles for Partial-Year Enrollees

If you enroll in a PSHB plan after the start of the calendar year—for example, during a Qualifying Life Event (QLE) such as a move, marriage, or retirement—you may find yourself dealing with a split-year deductible.

In these situations, the deductible usually resets for the new enrollment, regardless of what you paid in a prior plan. That means:

  • You could owe a full deductible amount even if you already paid one under your previous PSHB plan earlier in the year

  • Some plans may apply a pro-rated deductible, but this must be specified in the brochure

This is especially relevant for retirees who switch plans when transitioning from employee status or for Postal workers who marry mid-year and add family coverage.

Embedded vs. Aggregate Deductibles

Understanding how your deductible applies to family members is critical in 2025. PSHB plans either use embedded or aggregate deductibles:

  • Embedded: Each family member has an individual deductible amount. Once one person meets that amount, their benefits begin, even if the family deductible hasn’t been reached.

  • Aggregate: The full family deductible must be met before anyone gets coverage beyond preventive care.

For a family of four, this could mean the difference between paying $1,500 total (if one person hits their embedded deductible) vs. paying $4,000 before any coverage begins under an aggregate structure.

This distinction is typically hidden in footnotes or small-type explanations. Don’t assume that your plan’s deductible structure aligns with your prior experience—always confirm.

Deductibles and Medicare Coordination

If you’re a PSHB enrollee who also has Medicare Part B, your deductible requirements may change. In 2025, many PSHB plans offer reduced or waived deductibles for Medicare-covered enrollees.

This coordination can work in your favor, especially if your plan:

  • Waives the general in-network deductible if Medicare is primary

  • Applies lower copayments for services that are already covered under Medicare Part B

However, not all plans provide this coordination equally. Some still require the full deductible, while others only offer reduced amounts.

This is especially important for Postal retirees who are now Medicare-eligible. When choosing your PSHB plan, review how the plan interacts with Medicare—especially with regard to deductibles, prescription drug coverage, and cost-sharing reductions.

Don’t Let a Misleading Number Catch You Off Guard

The deductible amount printed on your PSHB plan summary can give you a false sense of security if you don’t fully understand the exceptions and alternate structures that might apply. In 2025, with greater plan complexity and rising healthcare costs, it’s essential to:

  • Read the plan brochure thoroughly

  • Review the Summary of Benefits and Coverage (SBC) section carefully

  • Check for any separate deductibles by category or provider type

  • Understand what applies to your family structure

  • Consider how Medicare integration impacts your deductible

If needed, get clarification before making plan changes or scheduling non-urgent procedures.

Get Clear Before You Commit to a Plan

Reviewing your deductible structure thoroughly can save you from hundreds—or even thousands—in unexpected costs. If you’re unsure which PSHB plan best aligns with your health needs, financial situation, or Medicare status, don’t guess.

Speak with a licensed agent listed on this website who can help you:

  • Break down your plan’s deductible by service category

  • Understand out-of-network risks

  • Evaluate coordination with Medicare

  • Compare plan structures across multiple scenarios

Making an informed decision now protects your budget and reduces stress later.