Key Takeaways

  • A deductible that seems reasonable on paper may turn out to be much more expensive once you begin using your PSHB plan, especially if you have recurring or unexpected health needs.

  • Understanding the fine details of how deductibles apply, especially in-network versus out-of-network and how they interact with other cost-sharing features, is essential to accurately estimate your yearly healthcare spending.

What Is a Deductible in the PSHB Context?

A deductible is the amount you must pay out of pocket before your Postal Service Health Benefits (PSHB) plan begins covering certain healthcare services. In 2025, most PSHB plans include a deductible that resets each calendar year. Once you meet this threshold, your plan starts to share costs for eligible services.

You might assume the deductible is a minor component of your total healthcare spending. After all, it’s just a number listed alongside premiums and copays. But if you overlook how frequently it applies and to what types of services, that “reasonable” figure can quickly become burdensome.

The Range of Deductibles Under PSHB in 2025

As of 2025, deductibles under PSHB plans generally fall into the following ranges:

  • In-network deductibles: $350 to $500 for low-deductible plans

  • High-deductible plans: $1,500 to $2,000 per year

  • Out-of-network deductibles: Can range from $1,000 to $3,000

These amounts vary based on your plan type and whether you’re enrolled in Self Only, Self Plus One, or Self and Family coverage. Importantly, each individual in a family plan may be subject to their own deductible, or the plan may use an aggregate model, meaning the total combined family spending counts toward a single deductible.

Why the Deductible Often Catches People Off Guard

A deductible might look manageable when viewed in isolation, but it rarely operates alone. Here’s why the real cost often ends up being higher than expected:

It Resets Every Calendar Year

Even if you meet your deductible in one year, it resets on January 1 of the next. If you have ongoing conditions, you’ll start from scratch annually.

Not All Services Count Toward It

Preventive care typically bypasses the deductible, but many common services do not. For example:

  • Diagnostic tests

  • Imaging (CT scans, MRIs)

  • Non-preventive office visits

  • Physical therapy

You may find yourself paying 100% of these costs until the deductible is met.

Out-of-Network Services Have Separate Deductibles

If you see an out-of-network provider, you may be responsible for a much higher deductible. And it won’t count toward your in-network total.

The Role of Deductibles in Overall Cost-Sharing

Understanding how deductibles fit into your broader financial responsibility under PSHB is crucial. They interact with other cost-sharing elements such as:

  • Copayments: Fixed amounts for specific services

  • Coinsurance: A percentage of the cost of care after the deductible is met

  • Out-of-pocket maximums: The cap on your total spending for the year

Deductibles are the gatekeeper. You must clear this financial hurdle before other parts of your plan kick in. And even after meeting your deductible, coinsurance may still apply.

A Closer Look at Family Deductibles

If you’re enrolled in a Self Plus One or Self and Family plan, you might be dealing with two types of deductible structures:

Embedded Deductibles

Each individual has their own deductible, and once one person meets it, the plan starts paying for that person. Once the combined family spending meets the family deductible, the plan pays for everyone.

Aggregate Deductibles

All spending contributes to a single family deductible. The plan doesn’t pay for anyone until the full family deductible is met.

Understanding your plan’s structure can have a significant effect on how costs add up, especially if more than one person in your family needs care in a given year.

Hidden Triggers That Activate Deductible Spending

You may be surprised at how easily everyday care leads to hitting your deductible:

  • Urgent care visits: A single visit could cost several hundred dollars

  • Lab work and imaging: These are often billed separately and can add up quickly

  • Physical therapy: Weekly sessions, even with in-network providers, may not be covered until the deductible is met

  • Emergency care: Even with in-network hospitals, some physicians or services may be billed out-of-network

Even a year that feels “normal” can push you into high out-of-pocket spending before your PSHB plan starts sharing costs.

Medicare and PSHB: How It Affects Your Deductible

If you’re a Medicare-eligible annuitant and also enrolled in a PSHB plan, your deductible situation may change. Many PSHB plans coordinate with Medicare Part B by reducing or even waiving certain deductibles. However, this only applies if you’re enrolled in both.

If you choose not to enroll in Medicare Part B (and you’re not exempt from the 2025 requirement), you may face higher deductibles, copayments, and coinsurance under PSHB. That makes coordination with Medicare an important financial consideration.

Annual Planning: Budgeting for the Deductible

You should always factor the deductible into your yearly budget, especially during the Open Season period from November to December. Use the following strategies:

  • Review plan brochures carefully: Look for separate in-network and out-of-network deductibles

  • Estimate your annual health usage: Include planned procedures, therapy, or routine care beyond preventive services

  • Check whether Medicare coordination applies: If you or a family member are Medicare-eligible, see how that may affect your deductible

Failing to plan for your deductible often results in surprise bills in the early months of the year.

Is a Higher Deductible Ever Worth It?

Higher-deductible PSHB plans typically come with lower monthly premiums. They may also offer tax-advantaged options such as a Health Savings Account (HSA), provided the plan qualifies as a high-deductible health plan.

However, a lower premium doesn’t always mean better value. If you end up needing more care than expected, a higher deductible could make your out-of-pocket costs significantly worse than a plan with higher premiums but lower upfront costs.

Before choosing a high-deductible plan:

  • Assess whether you can truly afford to meet the full deductible out of pocket

  • Consider how often you use healthcare services

  • Evaluate whether the plan qualifies for an HSA and how you plan to fund it

Deductibles vs. Out-of-Pocket Maximums: Know the Difference

Some PSHB enrollees confuse the deductible with the out-of-pocket maximum. These are not the same:

  • Deductible: The threshold you must meet before your plan starts sharing costs

  • Out-of-pocket maximum: The ceiling on total cost-sharing, including deductibles, copays, and coinsurance

In 2025, the PSHB out-of-pocket maximum is $7,500 for Self Only and $15,000 for Self Plus One or Self and Family (in-network). Once you hit this limit, the plan pays 100% of covered services for the rest of the year. However, you could pay thousands before you even reach that point.

Don’t Rely Solely on the Monthly Premium

When comparing PSHB options, many people focus almost exclusively on the monthly premium. While that figure is important, it’s only part of the equation. A low-premium plan with a high deductible might seem appealing until you’re paying several hundred or even a few thousand dollars early in the year.

Always weigh the deductible alongside other cost-sharing features:

  • Copays for office visits, specialists, urgent care, and emergency rooms

  • Coinsurance percentages for major services

  • Prescription drug tiers and cost structure

  • Out-of-network limitations and costs

The 2025 Enrollment Timeline: When to Reassess Your Deductible

The PSHB Open Season runs annually from November to December. This is your only chance (outside of qualifying life events) to reassess whether your current plan’s deductible still makes sense based on your healthcare needs.

By the time January 1 arrives, your deductible resets, and the plan you chose is locked in until the next Open Season. That’s why it’s critical to use the Open Season period to:

  • Recalculate expected healthcare usage

  • Compare in-network and out-of-network costs

  • Evaluate how much of your care is subject to the deductible

Think Beyond the Label of ‘Reasonable’

In isolation, a $500 deductible might seem reasonable. But in practice, what matters is how often you’re expected to pay that amount, how much additional cost-sharing follows it, and how it fits into your broader household budget.

If you’re only looking at the deductible number without understanding when and how it activates, you may find yourself paying far more than you anticipated.

Make Sure You’re Choosing Based on Total Cost, Not Just the Deductible

To make a smart PSHB plan choice in 2025, you need to look at the full picture. Use available tools, comparison charts, and speak with a licensed agent listed on this website who can help explain how deductibles interact with the rest of your plan.

Choosing a plan based solely on what looks like a “reasonable” deductible might lead to disappointment once real healthcare needs arise.

Your Deductible Isn’t Just a Number. It’s a Budget Priority.

What feels like a manageable deductible may become a financial hurdle if you’re not prepared for it. The better you understand how your PSHB deductible works, the more strategic you can be in choosing a plan that aligns with your health and financial goals.

For personalized help reviewing your deductible and overall PSHB plan options, get in touch with a licensed agent listed on this website.