Key Takeaways

  • Many PSHB enrollees overlook annual out-of-pocket expenses like deductibles, coinsurance, and cost-sharing limits when selecting a plan.

  • Even with government contributions, your total yearly costs can climb significantly based on how often you use your healthcare benefits.

Understanding the Bigger Picture Beyond Premiums

When you enrolled in a Postal Service Health Benefits (PSHB) plan, your attention probably went straight to the monthly premium. It’s the most visible cost and the one you see deducted regularly. But premiums are just the start. The real financial impact of a PSHB plan shows up in less visible annual costs that many workers and retirees don’t fully budget for.

These out-of-pocket costs can sneak up on you, especially in retirement when fixed incomes and frequent care needs become a reality. If you don’t account for the full picture, you may find yourself dipping into savings faster than you expected.

What the Government Covers—And What It Doesn’t

The federal government contributes around 70% of your total PSHB premium. While that helps significantly with your upfront costs, it doesn’t cover everything. Here’s what you’re still responsible for annually:

  • Your remaining share of the premium (monthly or biweekly)

  • Deductibles for both in-network and out-of-network services

  • Coinsurance percentages (especially if you receive specialty care)

  • Copayments for regular and specialist visits, urgent care, and ER

  • Out-of-pocket maximums, which cap how much you could pay in a year

Each of these factors can contribute hundreds or even thousands of dollars to your yearly healthcare spending.

1. Your Share of Premium Contributions

Even though you benefit from government support, your portion of the premium is a recurring, guaranteed cost. As of 2025, postal retirees contribute approximately $241.07 per month for Self Only coverage. For family coverage, that number rises significantly.

Multiply your monthly premium share by 12 and you’ll see that this is no small number. It’s the foundation of your yearly health spending—and that’s before you receive a single service.

2. Deductibles That Reset Each Year

Deductibles are another annual cost you may not have planned for. They reset every January, meaning even if you met your deductible late in the previous year, you start over from zero on January 1.

For example:

  • In-network deductibles typically range from $350 to $500 for low-deductible PSHB plans.

  • High-deductible plans can require $1,500 or more before coverage kicks in.

And if you need care outside of your plan’s network, your out-of-network deductible may be double or triple that.

3. Coinsurance That Quietly Adds Up

Coinsurance is the percentage you owe for services after meeting your deductible. Under most PSHB plans in 2025, coinsurance ranges:

  • In-network services: 10% to 30%

  • Out-of-network services: 40% to 50%

These numbers sound manageable at first. But if you undergo surgery, have multiple imaging scans, or require physical therapy, those percentages can translate into thousands in unexpected bills.

4. Copayments That Stack Throughout the Year

You likely budget for a few doctor visits a year. But copayments can multiply quickly when:

  • You’re managing a chronic condition

  • You visit multiple specialists

  • A family member falls ill

Typical PSHB copayments in 2025 include:

  • $20–$40 for primary care visits

  • $30–$60 for specialists

  • $50–$75 for urgent care

  • $100–$150 for ER visits

One ER visit combined with a few specialist appointments could push your total well into the hundreds within just a few months.

5. Out-of-Pocket Maximums: Helpful, But Still High

Out-of-pocket maximums act as a financial safeguard. Once you hit this threshold, your plan pays 100% of covered services for the rest of the year.

For 2025, PSHB plans typically set:

  • Self Only: Up to $7,500 (in-network)

  • Self Plus One/Family: Up to $15,000 (in-network)

This doesn’t include non-covered services or out-of-network expenses. If you or a dependent have a health event that pushes you to these limits, the burden is heavy—even if capped.

6. Prescription Drug Costs You Didn’t Expect

Prescription coverage is integrated with PSHB through Medicare Part D for eligible retirees. In 2025, the Part D out-of-pocket cap is $2,000 per year. This is a welcome change, but it’s still a cost that some retirees forget to plan for.

Also consider:

  • Some drugs fall outside formulary tiers

  • Non-covered drugs could require full out-of-pocket payment

  • Quantity limits may increase refill frequency and cost

Over a year, even common medications can lead to higher-than-expected spending.

7. Services Not Fully Covered by PSHB Plans

It’s easy to assume your health plan covers everything you might need. But PSHB plans still have limits and exclusions. These may include:

  • Dental and vision (unless separately enrolled in FEDVIP)

  • Hearing aids (limited or no coverage)

  • Long-term care services

  • Alternative therapies (acupuncture, chiropractic, etc.)

If you or a family member relies on any of these services, be prepared to pay out of pocket. The annual costs here can be substantial.

8. Traveling? Expect Extra Healthcare Costs

Traveling outside your network—or internationally—can lead to increased costs. Many PSHB plans have limited coverage for services rendered outside the U.S. If you travel regularly or live part-time abroad, you may face:

  • Higher out-of-network coinsurance

  • Upfront payments with later reimbursement

  • Limited emergency-only coverage in foreign countries

Even domestic travel may bring unexpected costs if you require care outside your plan’s network.

9. Annual Changes to Plan Design and Costs

Each November through December, PSHB Open Season gives you the opportunity to change plans. But if you don’t pay close attention to plan brochures, you could miss:

  • Increases in deductibles or copayments

  • Changes in provider networks

  • Coverage reductions for certain services

Starting January 1, these updates go into effect and can instantly raise your costs. You should always review the Annual Notice of Change and compare plan brochures to avoid surprises.

10. Medicare Integration Costs

If you’re retired and Medicare-eligible, PSHB plans coordinate with Medicare Part A and B. While this integration can lower your coinsurance and deductible burden, you need to be enrolled in Medicare Part B to take advantage.

As of 2025:

  • Standard Part B premium is $185/month

  • Annual deductible is $257

If you didn’t factor in these costs when planning your PSHB enrollment, your annual health budget may come up short.

How to Plan for These Annual Costs

Here are practical ways to stay ahead of your annual PSHB-related expenses:

  • Set aside a healthcare reserve. Budget annually for your deductible, copays, and some coinsurance.

  • Track usage trends. Look at the last year of care for you and your dependents to estimate next year’s needs.

  • Review plans during Open Season. Don’t auto-renew without reading plan changes.

  • Coordinate with Medicare. If eligible, enroll in Medicare Part B to get the full benefit of cost-sharing reductions.

  • Use FSA or HSA funds. If you’re still employed, consider setting aside pretax dollars to cover eligible expenses.

Why Being Proactive Makes a Financial Difference

You can’t avoid all healthcare costs, but you can prepare for them. The annual expenses tied to PSHB plans are manageable with foresight. Too often, retirees especially discover the real cost of care only after an unexpected bill arrives. Taking a closer look at your plan now means avoiding financial stress later.

Make Sure You’re Not Underestimating the True Costs

Your PSHB plan is a valuable benefit, but it comes with more financial responsibility than you might expect. From deductibles and coinsurance to prescription caps and Medicare coordination, the annual cost can quietly grow. You don’t have to face these choices alone. Connect with a licensed agent listed on this website to review your plan options and understand your full cost picture for 2025.