Key Takeaways

• You risk losing your Postal Service Health Benefits (PSHB) coverage if you fail to meet mandatory Medicare enrollment requirements once eligible.

• Understanding the timelines and exceptions for Medicare Part B enrollment is essential to maintain uninterrupted PSHB coverage and avoid financial consequences.

Medicare Enrollment Isn’t Optional for Everyone in PSHB

As of 2025, enrollment in the Postal Service Health Benefits (PSHB) Program comes with a critical requirement for Medicare-eligible retirees and their family members: enrolling in Medicare Part B when first eligible. This mandate is not simply a suggestion or a cost-saving strategy—it is a condition of maintaining your PSHB coverage.

If you misunderstand or ignore this requirement, you could lose your PSHB medical and prescription coverage entirely. The transition from the Federal Employees Health Benefits (FEHB) Program to PSHB includes new rules that weren’t applicable under FEHB, so it’s crucial you understand what has changed and how it affects you.

When Medicare Becomes Mandatory Under PSHB

Not every PSHB enrollee is required to sign up for Medicare Part B—but for many, it is mandatory. You must enroll in Medicare Part B if:

• You are entitled to Medicare Part A (usually premium-free), and

• You are a Postal Service annuitant or a covered family member who is entitled to Medicare Part A, and

• You are not exempt based on age or retirement date.

This requirement starts when you are first eligible for Medicare, which is typically the month you turn 65. You have a seven-month Initial Enrollment Period (IEP), which includes:

• Three months before your 65th birthday month

• Your birthday month

• Three months after your birthday month

Failure to enroll during this window, unless you qualify for a Special Enrollment Period, will result in the loss of PSHB coverage.

Who Is Exempt From Mandatory Enrollment

While the mandate is strict, it does not apply to everyone. You are exempt from the Medicare Part B requirement if:

• You retired from the Postal Service on or before January 1, 2025, and

• You are not already enrolled in Medicare Part B

Additionally, these categories are also exempt:

• You are actively working and covered under a PSHB plan

• You are under age 65 and not eligible for Medicare

• You live outside the United States and its territories

• You are receiving health benefits through the VA or Indian Health Service

If you fall into one of these categories, PSHB coverage will not be disrupted—even if you do not enroll in Medicare Part B.

What Happens If You Don’t Enroll

If you are required to enroll in Medicare Part B and fail to do so, your PSHB plan is required to terminate your medical and prescription drug coverage. This means:

• Your medical coverage under PSHB ends

• You lose access to the Part D Employer Group Waiver Plan (EGWP) that covers prescription drugs

• You will not be able to re-enroll in the drug portion of the plan later unless you qualify for a Special Enrollment Period in the future

This termination is not reversible unless you qualify for and act within a very limited special window.

Understanding the Role of Part B in PSHB Coordination

Medicare Part B is the foundation of how your PSHB plan coordinates benefits. Once you’re enrolled in both:

• Medicare becomes the primary payer

• PSHB becomes the secondary payer

Your PSHB plan is designed to work with Medicare by:

• Reducing or waiving deductibles

• Lowering or eliminating copayments

• Covering some services that Medicare does not

This coordination leads to significant out-of-pocket savings—but only if you’re properly enrolled.

Missed the Deadline? There May Be a Way Back

If you missed enrolling in Medicare Part B when you were first eligible, you may qualify for the General Enrollment Period (GEP), which runs January 1 through March 31 each year. Coverage then begins on July 1 of the same year.

However, this gap can be costly:

• You may be without PSHB medical and prescription coverage for several months

• You may have to pay a late enrollment penalty for Medicare Part B, which grows the longer you delay

• There is no guarantee you’ll be allowed back into your previous PSHB plan

Avoid this risk entirely by enrolling during your Initial Enrollment Period.

The Special Enrollment Period (SEP) and Its Limits

In certain situations, you may qualify for a Special Enrollment Period to enroll in Medicare Part B without penalty. These include:

• You or your spouse were actively working and covered by an employer group health plan

• You had coverage through the VA or Indian Health Services and are now changing providers

• You were living abroad and recently returned to the U.S.

These SEPs typically allow 8 months from the qualifying event to enroll. However, eligibility for SEP doesn’t automatically reinstate your PSHB plan. You must coordinate closely with both Medicare and OPM.

How to Verify Your PSHB Status and Medicare Coordination

To stay informed and compliant:

• Review your plan materials each year

• Check your Medicare status through the Social Security Administration

• Use the official PSHB tools, including LiteBlue (for employees) and KeepingPosted.org (for annuitants)

• Contact the PSHB Navigator Help Line at 1-833-712-7742 for enrollment support

You should also ensure your Medicare enrollment is confirmed in writing and recorded correctly with your PSHB plan.

Why Prescription Coverage Is Tied to Medicare Enrollment

In 2025, your PSHB plan’s prescription drug benefits are provided through a Medicare Part D Employer Group Waiver Plan (EGWP). If you are not enrolled in Medicare Part B:

• You are not eligible to receive the EGWP drug coverage

• Your prescription coverage will be terminated

• Re-enrollment will only be allowed under limited circumstances

This integration is automatic if you are properly enrolled in Medicare Part B. No separate action is needed for EGWP, but eligibility is linked directly to your Medicare status.

Medicare Premiums Are Separate From PSHB Premiums

One important distinction many overlook: enrolling in Medicare Part B means you pay the monthly Medicare premium in addition to your PSHB premium. They are separate programs with separate billing.

In 2025:

• The standard Medicare Part B premium is $185/month

• Some PSHB plans offer reimbursement features, but not all

Understanding that PSHB coverage does not replace your obligation to pay Medicare Part B premiums is essential.

Keep Your Coverage Safe By Staying Ahead

To ensure you never lose PSHB benefits due to Medicare enrollment issues:

• Mark your calendar for your Medicare eligibility window

• Enroll in Medicare Part B during your Initial Enrollment Period unless exempt

• Retain documentation of your enrollment and share it with your PSHB plan

• Stay informed annually through OPM, PSHB brochures, and your plan’s website

Letting deadlines slip or assuming exemptions that don’t apply can result in avoidable and sometimes irreversible losses in coverage.

Protect Your PSHB Access Before It’s Too Late

Understanding the Medicare enrollment requirements under PSHB is more than administrative—it directly affects your access to care, prescriptions, and financial well-being. With PSHB coordination rules in full effect for 2025, now is the time to ensure your compliance is up to date. If you’re unsure whether you need to take action or have questions about your exemption status, get help now.

For personalized assistance, reach out to a licensed agent listed on this website to walk through your Medicare options and PSHB responsibilities.