Key Takeaways

• Ignoring your PSHB deductible could delay or limit your access to full coverage benefits, particularly for specialist care, diagnostics, and hospital services.

• Understanding how and when your deductible resets—and how it interacts with copayments and coinsurance—is essential for budgeting and maximizing your plan in 2025.

What Your Deductible Really Represents in 2025

Your deductible isn’t just a number buried in your PSHB plan brochure. It’s a foundational threshold. Until you meet it, many services won’t be fully covered—especially those involving labs, imaging, surgeries, or hospital stays.

For 2025, most PSHB plans set deductibles between $350 and $1,500 for Self Only coverage, and higher for Self Plus One or Family coverage. If you delay meeting this deductible, you’re potentially paying more out-of-pocket than necessary or missing access to critical services altogether.

The Deductible Isn’t Optional—It’s a Gatekeeper

Before your PSHB plan begins sharing costs for many services, you must first meet your annual deductible. This includes:

• Specialist visits not covered by fixed copayments

• Outpatient procedures

• MRIs, CT scans, and other diagnostics

• Inpatient hospital admissions

• Some prescription drug tiers (especially in high-deductible plans)

Failing to track your deductible usage may lead you to mistakenly assume a service will be covered, only to face an unexpected bill.

Common Situations Where Deductibles Block Benefits

Many PSHB members assume that once they have insurance, they are immediately shielded from high medical costs. But these situations demonstrate where your deductible directly impacts your coverage:

• Early in the year: Deductibles reset every January 1. If you need a test or procedure in February, you’re paying out-of-pocket until that deductible is met.

• Out-of-network services: These may not count toward your in-network deductible, delaying access to in-network plan benefits.

• Plan changes: Switching plans during Open Season might mean starting a new deductible—even if you’ve already paid into one that year.

Copayments vs. Deductibles—They Don’t Count the Same Way

A $40 copayment for a primary care visit may feel like progress, but it typically doesn’t count toward your deductible. That’s because copayments and deductibles serve different roles:

• Copayments are flat fees for routine services, like a $30 charge for an office visit.

• Deductibles must be paid in full before cost-sharing like coinsurance kicks in for most non-routine services.

Many people overestimate their deductible progress because they’re conflating the two. Only the full, deductible-eligible charges count.

How Coinsurance Comes Into Play After You Meet the Deductible

Once you meet your deductible, you often transition to coinsurance. This is when your plan starts covering a percentage of your costs, and you cover the rest—typically 10% to 30% in-network under PSHB.

But here’s the twist: If you never reach your deductible, you may never get to the coinsurance stage, meaning your plan pays nothing toward some major services.

High-Deductible Plans: Why Ignoring the Deductible Is Especially Risky

Some PSHB enrollees choose high-deductible health plans (HDHPs) to pair with Health Savings Accounts (HSAs). While this approach works well for some, it requires full payment of the deductible—often $1,500 or more—before any cost-sharing begins.

In these plans, even:

• Generic prescriptions

• Specialist visits

• Lab work

may be fully out-of-pocket until the deductible is satisfied. If you ignore or underestimate this number, the financial impact can be significant.

PSHB Deductibles and Medicare Part B Coordination

If you’re a Medicare-eligible PSHB annuitant and enrolled in Medicare Part B, many PSHB plans reduce or waive deductibles altogether. However, this only applies after your Medicare Part B enrollment is confirmed and integrated with your PSHB coverage.

In 2025:

• Part B premiums are $185/month

• Part B’s annual deductible is $257

After this is met, Medicare generally becomes primary, and many PSHB plans pick up most or all of the remainder. Ignoring this integration step could mean continuing to pay your PSHB deductible needlessly.

Annual Reset: The Clock Starts Over Each January

Regardless of what you spent last year, your deductible resets on January 1.

This means:

• If you had surgery in November 2024 and hit your deductible, those benefits do not carry over.

• If your new deductible is $1,500 in 2025, it must be met again before cost-sharing resumes.

Being aware of this reset is essential to avoid budget shock, especially if your care needs are early in the year.

Tactics for Staying Ahead of Your Deductible

To make sure your deductible doesn’t surprise you, use these proactive steps:

• Track expenses: Log all deductible-eligible spending, even small procedures.

• Request an EOB (Explanation of Benefits): These often show how much of your deductible has been met.

• Call your PSHB plan: Ask directly how much of your 2025 deductible remains.

• Plan around resets: If possible, time non-urgent procedures late in the year once your deductible is met.

Don’t Let the Deductible Catch You Off Guard in Retirement

Many retirees believe that since they’re no longer on payroll, their PSHB plan will cover more automatically. That’s not the case. Deductibles still apply in full—unless coordinated with Medicare Part B.

Also, premium contributions and cost-sharing responsibilities may even increase post-retirement. Without a clear understanding of your deductible status, you may face:

• Delayed access to specialist care

• Full out-of-pocket costs for major treatments

• Higher annual healthcare spending

PSHB Family Coverage and Deductible Splits

If you’re enrolled in a Self Plus One or Self and Family plan, your deductible is higher, and shared between members. In 2025, these deductibles often range from $700 to $3,000.

It’s important to know:

• Some plans require one person to meet the entire family deductible before coverage begins.

• Others allow a per-person deductible up to a family cap.

Ignoring who’s met what can lead to confusion and claim delays.

Why This Matters More Than Ever in 2025

Deductibles have risen in 2025 across many PSHB plans, a trend mirroring broader health plan inflation. At the same time, more services have shifted toward coinsurance models rather than flat copays.

This means:

• You’re responsible for more upfront

• Failing to meet your deductible stalls access to core benefits

• Misunderstanding your deductible could cause financial strain

Protecting Your Benefits Starts With Understanding This Threshold

Your deductible isn’t just an accounting figure—it’s a critical financial gate between you and full access to your PSHB benefits. Whether you’re an active USPS worker or an annuitant, tracking and planning for this number is non-negotiable.

To ensure your deductible isn’t standing in the way of important care, speak with a licensed agent listed on this website. They can help you understand your plan’s structure, how Medicare fits in, and what steps to take now to reduce your out-of-pocket exposure.