Key Takeaways

• Missing or misunderstanding enrollment deadlines in the PSHB program can delay your access to care or increase your out-of-pocket costs for 2025.

• Avoiding common mistakes—such as failing to enroll in Medicare Part B when required or selecting the wrong coverage tier—can protect your benefits and your wallet.

Start With the Right Enrollment Timeline

The Postal Service Health Benefits (PSHB) Program, which officially took effect in 2025, replaces your previous FEHB plan if you’re a USPS employee or annuitant. While some enrollees were transitioned automatically, many still needed to take specific actions during Open Season or face serious consequences. Here’s what to know:

• Open Season occurs each year from November to December. This is your annual window to enroll, switch plans, or adjust coverage types.

• If you miss Open Season and don’t have a Qualifying Life Event (QLE), you generally must wait until the next year.

• Some transitions from FEHB to PSHB were automatic, but exceptions apply—especially for annuitants living abroad or Medicare-eligible individuals with complex eligibility statuses.

Failing to act within the timeline can mean coverage lapses or delays well into the following year.

Medicare Part B: Enrollment Isn’t Optional for Everyone

One of the most critical aspects of PSHB enrollment is how it integrates with Medicare. For 2025, specific groups are required to enroll in Medicare Part B to maintain full PSHB coverage:

• Annuitants who are Medicare-eligible and retired after January 1, 2025.

• Family members who are also Medicare-eligible under the same criteria.

If you’re subject to the Part B requirement and don’t enroll, your PSHB coverage may be suspended or denied for specific services.

What to do:

• Confirm whether you’re in a required group.

• If you’re turning 65 in 2025, enroll in Medicare Part B during your Initial Enrollment Period (three months before your 65th birthday, your birth month, and three months after).

• If you missed enrolling due to lack of information, the Special Enrollment Period (April 1 to September 30, 2024) may have applied—but that window is now closed.

Misunderstanding Coverage Tiers Can Raise Costs

PSHB plans often appear similar on the surface—but coverage tiers vary greatly. Many employees and retirees make costly errors by assuming all Self Plus One or Self and Family plans include the same benefits or provider access. In reality:

• In-network vs. out-of-network services may carry significantly different coinsurance rates.

• Some plans cover fewer specialists or pharmacy networks within your area.

• Choosing a higher tier than needed can increase your monthly premium without adding real value.

Review the plan brochure and provider network details carefully. Don’t assume your previous FEHB plan offers identical coverage in PSHB form.

Dual Enrollment Confusion Leads to Duplicate Costs

Another recurring mistake involves retirees or dual-eligible family members maintaining both PSHB and separate private Medicare Advantage or Part D plans. While this may sound like more coverage, it often results in:

• Duplicate premiums that don’t deliver additional value.

• Coordination issues that can lead to denied claims.

• Loss of key PSHB prescription drug benefits if you opt out of the Medicare Part D EGWP embedded in many PSHB plans.

In 2025, the integrated drug benefit through PSHB includes a $2,000 out-of-pocket cap and broader access through the Employer Group Waiver Plan (EGWP). Opting out could limit access to preferred pharmacy networks or raise your annual expenses.

Relying on Automatic Enrollment Can Backfire

While many USPS employees and annuitants were told they’d be automatically enrolled in a PSHB plan, this doesn’t guarantee the outcome you want—or even need. Here’s what often goes wrong:

• Your auto-assigned plan may not match your health needs.

• Medicare coordination may not occur unless you’re already enrolled in Part B.

• If you were on a family member’s FEHB plan but aren’t USPS-affiliated, you must take new action—you’re not transitioned automatically.

Always check the confirmation notice sent during Open Season. If it never arrived or was unclear, contact the PSHB Navigator Help Line.

Missing Documentation or Incomplete Forms

Even if you submit your election during Open Season, your PSHB enrollment can be delayed or denied if any part of the paperwork is incomplete:

• Missing dependent verification for Self Plus One or Self and Family coverage.

• Incorrect Social Security numbers or mismatched Medicare information.

• Using outdated FEHB enrollment forms instead of the PSHB-specific system.

To ensure your paperwork is complete:

• Use official USPS enrollment platforms such as LiteBlue (for employees) or KeepingPosted.org (for annuitants).

• Upload or submit verification documents promptly, especially for dependents or Medicare enrollment.

• Double-check confirmation emails or print your submission receipt.

Misjudging Costs by Skimming Plan Summaries

Skimming a summary chart or cost table can leave you blind to the hidden expenses in a plan. Many enrollees focus on monthly premiums and overlook these areas:

• Annual deductibles, which can range from $350 to over $1,500 depending on your plan.

• Copayments for specialists, ER visits, and urgent care, which can differ widely even among plans with similar premiums.

• Coinsurance percentages for major services like surgeries or inpatient stays.

A plan that appears affordable up front may cost you significantly more throughout the year. Use the full PSHB plan brochure—not just the summary pages.

Forgetting About Out-of-Pocket Maximums

Every PSHB plan has an in-network out-of-pocket maximum—but out-of-network limits can be far higher or even uncapped. If you:

• Live in a rural area,

• Travel frequently, or

• See specialists outside your network,

you could quickly exceed your intended budget.

In 2025, common in-network out-of-pocket maximums are around $7,500 for Self Only and $15,000 for Self Plus One or Family. Out-of-network expenses can go well beyond this range, depending on the plan.

Check both in-network and out-of-network figures before you decide.

Overlooking Plan Differences for Annuitants vs. Active Employees

Some annuitants assume they’ll receive the same benefits and contribution levels as active employees—but that’s not always the case under PSHB.

• Biweekly premium contributions are higher for annuitants in most plans.

• Access to certain Medicare integration benefits, like waived deductibles or premium reimbursements, varies.

• The plan’s prescription drug coordination may be structured differently based on your Medicare status.

Always check the annuitant-specific plan version. These differences are especially important if you’re deciding whether to opt into Medicare Part B.

Believing You Can Fix Mistakes After Open Season

Some enrollees think they can resolve issues once Open Season ends—but PSHB does not allow midyear changes unless you experience a Qualifying Life Event such as:

• Marriage or divorce

• Birth or adoption of a child

• Loss of other health coverage

• Relocation affecting plan service area

If your plan was incorrectly selected or you failed to enroll, you’ll likely be locked into that mistake for the rest of the calendar year.

Being proactive during Open Season is critical—don’t rely on retroactive corrections.

Making Smart Moves Before the Next Open Season

As a PSHB enrollee or future participant, your decisions during Open Season shape your access to care and financial stability for the year ahead. If you:

• Recently retired,

• Are turning 65 soon,

• Have Medicare-eligible family members,

then reviewing plan options thoroughly is essential. Now is the time to:

• Gather full brochures for the top plans you’re considering.

• Compare coinsurance, deductibles, and out-of-pocket maximums.

• Ensure Medicare Part B enrollment if required.

• Use USPS tools and help lines for clarification.

Don’t Let Simple Mistakes Jeopardize Your 2025 Coverage

PSHB enrollment gives you access to a wide range of health benefits—but only if you approach it with full awareness of the timelines, documentation, and plan features. A wrong assumption or overlooked detail could mean higher costs or denied coverage.

Make sure your next Open Season decisions are based on facts, not assumptions. If you’re unsure about plan selection, Medicare coordination, or eligibility, speak with a licensed agent listed on this website for guidance.