Key Takeaways

• Choosing the right PSHB coverage level in 2025 can significantly impact your out-of-pocket costs and benefits access, especially as a Postal Service retiree or employee.

• Your Medicare status, family size, and healthcare usage patterns should all influence which PSHB tier you select during Open Season.

Understanding the PSHB Coverage Levels

The Postal Service Health Benefits (PSHB) Program officially took effect on January 1, 2025, replacing the former FEHB coverage for USPS employees and retirees. With this transition, one of the most important decisions you face is selecting the right coverage level: Self Only, Self Plus One, or Self and Family.

These levels determine how much you pay in premiums, who is covered under your plan, and what out-of-pocket costs you may face during the year. Choosing wisely can help you balance coverage needs with financial limits.

Coverage Levels Explained

Here’s what each level includes:

• Self Only: Just you. Ideal if you’re single or your spouse has other health coverage.

• Self Plus One: You and one eligible dependent. This could be your spouse or one child.

• Self and Family: You and multiple eligible dependents. This includes a spouse and/or children under age 26 (or older if disabled).

Each of these levels includes access to the same basic benefits, but premiums and cost-sharing vary.

1. Self Only: When It Makes the Most Sense

This plan level works best if:

• You don’t have any eligible dependents.

• Your spouse is already covered under another health insurance plan.

• You’re retired and living alone with few healthcare needs.

In 2025, this level typically results in the lowest premium costs, making it a practical choice for individuals who rarely use healthcare services. But be cautious: if your health changes unexpectedly, you won’t be able to switch levels until the next Open Season (or a qualifying life event).

What You’re Getting

• Preventive care, specialist visits, and hospital stays for yourself

• Prescription drug coverage (integrated with Medicare Part D if you’re eligible)

• Mental health and wellness services

2. Self Plus One: Often Overlooked but Sometimes Overpriced

This level has its pros and cons. While it’s designed for a two-person household, it doesn’t always save you money compared to Self and Family. In fact, in some cases, Self Plus One has higher premiums than Self and Family.

It might make sense for:

• Married couples with no children

• Single parents with one child

Things to Watch For

• Premiums in 2025 may not be significantly lower than Self and Family.

• If your eligible dependent develops ongoing medical needs, ensure the plan offers robust specialist and hospital coverage.

What You’re Getting

• Coverage for two people

• Lower cost-sharing than many private alternatives

• Full access to PSHB benefits, including mental health, preventive care, and prescriptions

3. Self and Family: For Broader Coverage

This plan level is appropriate for USPS employees or retirees with more than one dependent. It provides flexibility, especially for families with children or adult dependents who qualify.

You might choose this level if:

• You have more than one dependent to cover

• Your children are under 26 or disabled

• You’re supporting a household with multiple medical needs

What You’re Getting

• Coverage for you and all eligible family members

• Consistent cost-sharing across services

• Typically the highest premiums, but often more cost-effective than managing multiple plans

Medicare Part B and Its Impact on PSHB Levels

In 2025, if you’re a Medicare-eligible annuitant, your PSHB coverage is coordinated with Medicare Part B. In many PSHB plans, this coordination results in lower deductibles, coinsurance, and even prescription costs when both coverages are in place.

If You Have Medicare Part B

• Self Only: You may benefit from waived deductibles and reduced out-of-pocket costs.

• Self Plus One or Self and Family: You and any other Medicare-eligible dependents can gain from cost-sharing reductions.

If you retired before January 1, 2025, you’re exempt from mandatory Medicare Part B enrollment, but it’s still worth evaluating if the additional monthly premium is balanced by your savings in cost-sharing under PSHB.

Financial Considerations in 2025

When choosing your PSHB level, consider both monthly premiums and out-of-pocket exposure like deductibles, coinsurance, and copayments.

Some general trends in 2025:

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

• Out-of-pocket maximums go as high as $15,000 for families.

• Government covers around 70% of the total premium cost.

High healthcare usage may justify a higher premium in exchange for lower cost-sharing, especially if you or your dependents have chronic conditions.

Family Size and Coverage Level Myths

A common misconception is that Self and Family is always the most expensive. While premiums are higher, the value increases as you add more dependents. For families with three or more members, the cost per person actually decreases.

Also, remember that:

• You can’t switch levels mid-year unless you have a Qualifying Life Event (QLE), such as marriage, divorce, or birth of a child.

• Only eligible dependents count—nieces, nephews, or adult children over 26 without disabilities aren’t covered.

Comparing Open Season Changes

During Open Season (November to December), you can:

• Review current enrollment level

• Compare different PSHB plans and cost-sharing structures

• Make changes to your level if your family or health situation has changed

It’s important to prepare in advance. Look at how your family used healthcare in 2024. Did you meet your deductible? Did someone need out-of-network care? Are your prescriptions changing in 2025?

Evaluating these questions can guide you toward the right level.

Coverage and the Hidden Costs of Underinsurance

Choosing a lower level to save on monthly premiums can backfire if you experience high medical costs unexpectedly. Underinsurance happens when your plan doesn’t provide enough protection for your actual needs.

Warning signs:

• Skipping medical appointments due to high copayments

• Delaying prescriptions to avoid out-of-pocket drug costs

• Using urgent care instead of specialists because of cost-sharing fears

If these apply to you or your dependents, it may be time to consider switching to a broader coverage level.

Planning for Life Changes in 2025

Changes in your life can impact your PSHB needs:

• Retirement: If you’re retiring in 2025, reassess your plan to ensure it supports your Medicare coordination.

• New Dependents: Marriage, birth, or adoption will allow mid-year changes.

• Loss of Other Coverage: If your spouse loses employer coverage, you may need to move from Self Only to Self Plus One.

Always report these events promptly to avoid gaps in coverage.

Making Your Decision During Open Season

Take advantage of these steps:

• Use the PSHB comparison tools available online or through your HR portal.

• Estimate your likely usage based on last year’s claims.

• Double-check that all dependents you want to cover are eligible.

• Review plan brochures for specifics about cost-sharing, provider networks, and Medicare integration.

Selecting the right level is not just about cost—it’s about ensuring peace of mind and access to care when you need it most.

Choosing Wisely for 2025 and Beyond

Your PSHB coverage level plays a major role in how well you’re protected against medical costs. Whether you’re an active USPS employee or a retiree, it’s important to align your plan with your personal circumstances, dependents, and Medicare status.

As 2025 progresses, reevaluate your level annually to keep up with life changes and healthcare needs. When in doubt, get in touch with a licensed agent listed on this website for help comparing your options and finding the coverage level that works best for you.