Key Takeaways

• The true financial burden of copayments under your PSHB plan may not lie in how much you pay, but in how often you’re expected to pay them throughout the year.

• Knowing when copays apply—and planning for their frequency—can help you better manage recurring healthcare costs and avoid budget surprises.

Understanding the Purpose of Copayments

Copayments are flat fees you pay out of pocket for specific healthcare services. They’re intended to promote shared responsibility and discourage unnecessary care. Under Postal Service Health Benefits (PSHB) plans in 2025, copayments are common for services such as:

• Primary care and specialist visits

• Urgent care and emergency room visits

• Prescription drug pickups

• Mental health consultations

• Preventive services not fully covered under your plan

At first glance, these fees might seem manageable. But when multiple copays stack up over time—especially if you or a family member has ongoing health issues—they can begin to take a significant toll.

The Real Issue: Frequency Over Cost

What many PSHB enrollees overlook is how often copays are triggered. Even relatively low copay amounts can lead to financial strain if applied frequently throughout the year. For example:

• Weekly physical therapy sessions

• Multiple monthly prescriptions

• Biweekly mental health appointments

• Several urgent care visits for a child with recurring infections

It’s the accumulation of these payments—not just the size of each one—that can quietly erode your budget.

Why Copayments Can Add Up Fast

There are several reasons why copayments under PSHB plans tend to become more frequent than people expect:

1. Routine Care Isn’t Always Covered Fully

Annual physicals and some screenings may be covered at no cost, but many other services aren’t. Follow-up appointments, specialty care, and diagnostic tests often involve separate copays.

2. Prescription Drugs Are a Monthly Expense

Most prescriptions require a copayment each time you fill or refill a medication. If you or a family member is on maintenance medications, that can mean 12 copays a year per medication—or more if quantities are limited to 30-day supplies.

3. Urgent Care Can Be a Repeated Occurrence

Urgent care visits tend to spike during flu season or when unexpected issues arise. Many families turn to these centers because they’re faster and more convenient than scheduling a primary care appointment. But each visit carries its own copay.

4. Copays Apply Per Visit, Not Per Illness

If your treatment spans multiple sessions—like physical therapy or counseling—expect to pay a copayment for each visit, regardless of whether it’s part of the same medical condition.

How to Estimate Your Annual Copay Load

Planning ahead is key to controlling how copayments affect your annual finances. Here’s how to roughly estimate your yearly exposure:

• Review your 2024 usage: Look at how often you visited healthcare providers last year and for what reasons.

• Multiply by copayment type: Apply the current copay amount for each type of visit.

• Include prescription drugs: Tally the number of recurring prescriptions and multiply by 12 (or however frequently you refill).

• Account for dependents: If you have family members on your plan, repeat this process for each person.

This method gives you a conservative estimate of your expected annual out-of-pocket costs from copayments alone.

Why Tracking Frequency Matters in 2025

With healthcare prices trending upward in 2025, tracking how often you’re charged copayments is more important than ever. A few reasons why:

• Cost visibility: Copays often seem small individually, so it’s easy to lose sight of their cumulative impact.

• Budget planning: Awareness allows you to allocate funds specifically for healthcare.

• Plan comparison: When evaluating or changing plans during the next Open Season (November–December), understanding your copay usage can help you choose a plan that aligns with your care patterns.

When Copays Are More Likely to Catch You Off Guard

Certain situations make it more likely that copayment frequency will become an issue:

• Chronic conditions: Ongoing care means repeated visits, each with a new copay.

• High family usage: When multiple members require frequent care, copayments multiply quickly.

• Unpredictable health events: A sudden injury or illness can result in a flurry of appointments, prescriptions, and urgent care visits.

These scenarios highlight the importance of having a buffer or setting aside part of your budget for potential bursts of activity.

Copayments vs. Other Out-of-Pocket Costs

It helps to distinguish copayments from other forms of out-of-pocket spending:

• Copayment: A fixed amount due at the time of service.

• Deductible: A set amount you must pay each year before your plan begins to pay a share.

• Coinsurance: A percentage of the cost of care you share with your plan after meeting the deductible.

Unlike deductibles or coinsurance, copayments apply regardless of whether you’ve met your deductible. That’s why they tend to be more frequent and feel more immediate.

Timing Matters: How Copays Accumulate Throughout the Year

Your copayments aren’t likely to be evenly spread throughout the calendar year. Here’s how the timing typically plays out:

• January to March: You may start scheduling annual checkups or specialist consultations.

• April to June: Allergy and cold symptoms increase medical visits, especially for children.

• July to September: Summer travel and activities often lead to more urgent care visits.

• October to December: Flu season, holiday stress, and last-minute appointments before the year ends can spike healthcare usage.

Being aware of this pattern can help you prepare financially for seasonal surges.

Ways to Stay Ahead of Copay Accumulation

Rather than being caught off guard, you can take steps to manage the financial burden of frequent copayments:

• Track usage with a calendar: Mark each time you or your family sees a doctor or fills a prescription.

• Build a monthly healthcare budget: Set aside a dedicated amount based on your estimated frequency.

• Choose in-network providers: These typically carry lower copays.

• Bundle visits when possible: Try to schedule multiple concerns into one appointment.

• Use telehealth for certain services: Many PSHB plans offer virtual visits at reduced copayments.

Open Season: When Frequency Becomes a Deciding Factor

Open Season—running from November to December each year—is your chance to review and adjust your health plan. If you’ve been surprised by how often you’re paying copays, this period is your opportunity to:

• Evaluate how your current plan handles frequent visits

• Compare other PSHB plans with potentially lower copays or better chronic condition management

• Project your expected usage for the upcoming year and align your plan accordingly

Understanding copayment frequency gives you leverage when making plan decisions.

Common Myths About Copays

Let’s clear up some misunderstandings that could cost you more than necessary:

• “I already paid for this condition once.” Unfortunately, every appointment counts separately. Unless it’s part of a bundled care episode (rare), expect a new copay for each visit.

• “Preventive care is always free.” While some screenings are, many follow-up services or lab tests are not.

• “Generic drugs don’t have copays.” Most do. The copay may be lower, but it’s still there.

• “Urgent care is cheaper than the ER.” Sometimes true, but both still carry copays—and frequent visits add up.

Recognizing these realities helps you plan more effectively.

What to Ask Before Your Next Visit

To avoid copayment surprises, consider asking your provider or plan the following before scheduling an appointment:

• Will there be a copayment for this service?

• Are there multiple visits involved?

• Are all parts of the service considered preventive?

• Is the provider in-network under my current PSHB plan?

Proactively asking these questions can give you clarity and control.

Staying Informed Is Your Strongest Strategy

In 2025, with healthcare usage patterns changing and costs continuing to rise, staying informed about how your copayments work is essential. Many PSHB members assume their coverage is all-inclusive, only to discover that high-frequency visits come with repeated charges. Treat your plan like a financial tool—one that requires regular review and smart planning.

Copayment Frequency Deserves Your Attention This Year

What might appear to be a small fee at first glance can become a major line item in your budget over time. With PSHB plans, the key isn’t just knowing how much your copays are—it’s tracking how often they hit your wallet. You deserve to make decisions based on the full picture.

If you’re unsure whether your current plan fits your usage pattern, get in touch with a licensed agent listed on this website for professional advice tailored to your situation.