If PSHB Seems Affordable at First Glance, You Might Be Missing the Bigger Equation

Key Takeaways

• The true cost of your PSHB plan in 2025 goes far beyond the monthly premium. You need to consider deductibles, coinsurance, copayments, and how your plan interacts with Medicare.

• Rushing into a plan based on the lowest premium can leave you underprepared for high out-of-pocket expenses that arise once care is actually needed.

What PSHB Costs Look Like on the Surface

At first glance, the Postal Service Health Benefits (PSHB) program appears to be affordable, especially if you’re comparing monthly premiums alone. With options available across Self Only, Self Plus One, and Self and Family tiers, you might quickly assume your healthcare costs will remain low year-round.

But this impression can be misleading.

Premiums are just the beginning of the PSHB cost structure. To fully understand what you may owe, you must look deeper into:

• Annual deductibles

• Copayments and coinsurance

• Prescription drug costs

• Maximum out-of-pocket limits

• Your eligibility for Medicare Part B and its impact on total costs

These factors often add up significantly over the course of a year, especially if you or a family member require regular or unexpected medical care.

The Role of Deductibles in Annual Costs

Every PSHB plan has an annual deductible you must pay before most benefits start. In 2025, these typically range:

• Between $350 to $500 for in-network services in standard low-deductible plans

• As high as $1,500 to $2,000 for high-deductible health plans (HDHPs)

If you’re in good health and rarely visit a doctor, this deductible might not seem like a concern. But the moment you face a hospitalization or specialist visit, you could hit that threshold quickly.

What’s often overlooked is how much of your care applies toward the deductible. Not all services do. Routine care may be covered outright, but imaging, outpatient surgery, and non-preventive treatments often require you to first meet the deductible.

Copayments Add Up Quickly

Many PSHB plans offer fixed copayments for services like primary care, specialists, urgent care, and emergency rooms. A $20 to $60 copay may not sound alarming, but these payments accumulate fast if you use care often.

Here’s what typically carries copayments:

• Office visits

• Lab work

• Imaging

• Physical therapy

• Urgent or emergency visits

Even two or three medical needs per month could result in hundreds of dollars per quarter. That’s why a plan that looks affordable in January can begin to feel expensive by June.

Coinsurance Can Be the Wildcard

Coinsurance is a percentage of the cost you owe for certain services, usually after meeting your deductible. In 2025, PSHB coinsurance rates can be as low as 10% in-network and as high as 50% out-of-network.

This becomes especially critical if:

• You have a surgery that costs thousands of dollars

• You require ongoing specialty care

• You use out-of-network providers by necessity or accident

Unlike copayments, which are flat, coinsurance fluctuates based on the cost of service. That unpredictability makes budgeting difficult unless you fully understand your plan’s structure.

Prescription Drug Costs: The Extra Tier

Your PSHB plan automatically includes prescription drug coverage, and if you are Medicare-eligible, it will coordinate with a Medicare Part D Employer Group Waiver Plan (EGWP).

In 2025, Part D includes a $2,000 cap on out-of-pocket drug costs. This helps significantly, but only if you are enrolled in both Medicare Part B and the corresponding PSHB plan. If not, you may face:

• High tiered copays for brand-name medications

• Separate drug deductibles

• More restrictive formularies

Some plans waive or reduce drug costs if you have Medicare. If you don’t, you may shoulder the full burden yourself.

Don’t Overlook the Out-of-Pocket Maximum

The out-of-pocket maximum is your financial safety net. Once you reach this amount through deductibles, copays, and coinsurance, the plan pays 100% of covered services for the rest of the year.

For 2025 PSHB plans, in-network out-of-pocket limits are:

• $7,500 for Self Only

• $15,000 for Self Plus One and Self and Family

That’s significant. If you or a family member experience a serious medical issue, you could find yourself on the hook for the full maximum within just a few months. And if your care includes out-of-network providers, the financial exposure can be even higher, as out-of-network costs may not count toward the in-network limit.

How Medicare Part B Changes the Equation

If you are 65 or older or otherwise eligible for Medicare, your PSHB plan cost structure changes. Many plans integrate with Medicare Part B to reduce your out-of-pocket expenses, sometimes even offering premium reimbursement or waiving cost-sharing altogether.

But this only applies if you are enrolled in both:

• Medicare Part B (which has its own premium of $185 in 2025)

• A PSHB plan that provides enhanced coordination

If you decline Part B, you may:

• Miss out on reduced deductibles and coinsurance

• Be ineligible for premium reimbursements

• Pay higher prescription costs

The additional cost of Medicare Part B may seem like a burden, but for many, it ends up reducing overall healthcare expenses when properly coordinated.

Looking Beyond Monthly Premiums When Comparing Plans

It’s easy to default to the plan with the lowest premium during Open Season. But what you save monthly can easily be erased by:

• A high deductible you weren’t expecting

• Frequent copays for chronic care

• Expensive prescriptions that fall into a high tier

• A hospital stay triggering coinsurance

Instead, consider these questions when comparing:

• What services do you or your family use regularly?

• Are your providers in-network?

• Do you anticipate any major procedures in the next year?

• Are you eligible for and enrolled in Medicare Part B?

Total cost of care is always a better decision point than monthly premium alone.

Timing and Enrollment: Why It Matters

The PSHB Open Season runs each year from November to December. This is the only time you can make changes unless you qualify for a Special Enrollment Period due to life events like marriage, divorce, or retirement.

Plan choices you make during Open Season go into effect the following January. So if you’re estimating costs now, you’re planning for the entire 2025 calendar year.

Missing the Open Season or misunderstanding plan details can leave you locked into a costly option for 12 months.

Federal Contributions Don’t Eliminate Risk

The federal government continues to pay roughly 70 to 72% of the total premium for your PSHB plan. While this subsidizes your monthly premium, it does not change the remaining financial responsibility you bear once care is needed.

In fact, the generous contribution might lead to underestimating your true exposure. You still owe:

• The employee/annuitant share of the premium

• All deductibles and coinsurance until the out-of-pocket limit is reached

• Drug costs depending on your Medicare status

Government contributions ease the initial burden but don’t remove the need for smart plan selection.

Getting Help to See the Full Picture

Understanding all these moving parts on your own can be difficult. That’s where professional guidance can make a real difference.

Licensed agents familiar with PSHB plans can help you:

• Compare total cost projections across plans

• Understand Medicare coordination details

• Break down deductibles and copays based on usage

• Identify plans that reduce exposure for chronic or high-cost care

What may seem affordable based on surface-level data could turn out to be one of your most expensive choices. A second opinion can prevent long-term regret.

You Owe It to Yourself to Think Beyond the Premium

While PSHB makes health insurance more accessible for USPS employees and annuitants, affordability doesn’t stop at the premium. In 2025, the real costs show up in how often you use care, how your plan handles each service, and whether you’ve coordinated with Medicare effectively.

Instead of defaulting to what looks cheapest, build a realistic estimate of your annual needs. Add in deductibles, coinsurance, prescriptions, and out-of-pocket caps. If you’re Medicare-eligible, don’t skip Part B without understanding the trade-offs.

The smarter path? Get in touch with a licensed agent listed on this website who can walk you through the details and help you select a PSHB plan that fits your health needs and financial comfort zone.