Key Takeaways

• A few simple missteps during Postal Service Health Benefits (PSHB) enrollment can lead to higher costs or a lapse in coverage.

• Understanding eligibility, Medicare coordination, and timing rules helps you avoid regrets down the line.

Not Reading the Fine Print Can Hurt You

You’ve got a lot going on—work, retirement planning, maybe even Medicare decisions. But skipping the PSHB plan brochures or rushing through enrollment is one of the easiest ways to end up with a plan that doesn’t suit your needs. The PSHB program has some new rules, especially in 2025, and they’re not just minor tweaks.

If you’re an active USPS employee or annuitant, this year marks a major shift from FEHB to the PSHB program. Every plan has a slightly different setup when it comes to deductibles, copayments, coinsurance, and out-of-pocket limits. If you choose without comparing, you might end up overpaying for care you rarely use—or worse, not having enough coverage when you actually need it.

What to watch for:

• Deductible differences that vary between $350 and over $2,000

• Coinsurance that could range from 10% to 50%

• Out-of-pocket caps that may go as high as $15,000 for family plans

Bottom line: take the time to compare plan brochures thoroughly, even if it takes a couple of hours. It can save you thousands later.

Waiting Too Long to Act

Enrollment deadlines are more than just suggestions—they’re strict. The PSHB Open Season runs from November to December, and outside of that, you only get a shot at switching or enrolling if you experience a Qualifying Life Event (QLE). If you miss your window, you could be stuck with a plan you didn’t want or lose coverage entirely.

Key dates to know:

• PSHB Open Season: Typically November through mid-December

• Effective date for changes: January 1 of the following year

Whether you’re working or retired, mark these dates in your calendar. Set a few reminders. Missing the deadline could cost you a whole year of better coverage or lower costs.

Assuming Medicare Enrollment Isn’t Required

A lot of confusion is floating around about Medicare and how it pairs with the new PSHB plans. If you’re a USPS annuitant or family member and you’re eligible for Medicare Part B, it’s now required in many cases to keep your PSHB coverage.

This change affects retirees who:

• Retired after January 1, 2025, and

• Are age 65 or older (or have family members who are)

Failing to enroll in Medicare Part B when required could mean losing your PSHB plan altogether. The rule also applies to some covered family members, so don’t assume you’re safe just because you’re not 65 yet.

Forgetting to Coordinate Your Coverage

Let’s say you’re covered by a family member’s PSHB plan. If you’re also eligible for your own Medicare or health coverage, coordination matters. Overlapping plans can either help you or hurt you depending on how they interact.

If you don’t coordinate properly:

• You might pay more in premiums than necessary

• You could run into denied claims or limited benefits

• Your secondary plan might not kick in the way you expect

Coordination becomes even more critical if Medicare is involved. For most retirees, Medicare pays first, and your PSHB plan pays second. But if you mess up the coordination, you could be left paying out-of-pocket for services that should’ve been covered.

Ignoring Prescription Coverage Changes

Starting in 2025, prescription drug coverage for Medicare-eligible annuitants and their families will come through a Medicare Part D Employer Group Waiver Plan (EGWP) tied to their PSHB plan. This is automatic, but you need to know how it works.

If you enroll in a standalone Medicare Part D plan outside your PSHB coverage, you could get kicked out of your PSHB prescription benefits. That’s not a small mistake—it could lead to:

• Higher drug costs

• Disruption in access to preferred medications

• Unexpected gaps in coverage

Stick with the PSHB-linked prescription plan unless a licensed agent confirms a better route.

Overlooking Your Out-of-Pocket Risk

You might think your premiums are the main cost to watch—but that’s only part of the picture. Your deductible, coinsurance, and out-of-pocket maximum all affect how much you really spend each year. Some plans look affordable upfront but leave you wide open to big expenses when you need care.

In 2025, out-of-pocket maximums can reach:

• $7,500 for Self Only

• $15,000 for Self Plus One and Self & Family

If you or a family member sees specialists, takes multiple prescriptions, or needs recurring care, you’ll want a plan with manageable out-of-pocket limits—even if the premium is a little higher.

Assuming Your Current Coverage Will Carry Over Automatically

Automatic enrollment does happen—but that doesn’t mean you should just sit back. If you’re an FEHB enrollee, you’ll be moved to a similar PSHB plan. But the word “similar” is doing a lot of heavy lifting here. Plan details may differ in cost-sharing, benefits, provider networks, or coverage area.

You should still:

• Review your PSHB plan details carefully

• Compare them to your previous FEHB benefits

• Make a switch during Open Season if something looks off

Passive enrollment might save you time now, but it could cost you more if you don’t double-check the details.

Misunderstanding Family Member Eligibility

Family coverage isn’t one-size-fits-all. Not everyone who lived under your roof before is automatically eligible now. PSHB uses federal rules to define who qualifies as a family member, and if someone doesn’t meet those criteria, their coverage might not be valid.

Eligible family members usually include:

• Spouse

• Children under age 26

• Certain disabled adult children

That’s it. Not included? Domestic partners, parents, siblings, or other relatives—even if you’ve supported them financially for years. Make sure you’re not assuming someone’s covered when they’re not.

Not Considering Future Healthcare Needs

It’s tempting to pick a plan based on how you feel today. If you’re healthy, you might lean toward a high-deductible option with a lower premium. But what happens if things change?

Chronic conditions, planned surgeries, or unexpected health issues can turn your cheap plan into a pricey one fast. When choosing a PSHB plan:

• Think about your long-term health

• Look at network flexibility and specialist access

• Consider benefits for vision, hearing, and dental (if important to you)

Your future self will thank you for planning ahead.

Failing to Get Help When You Need It

This stuff isn’t always intuitive. There are forms, deadlines, eligibility rules, Medicare coordination rules—it’s a lot. One of the most expensive mistakes you can make is assuming you don’t need help.

Instead of guessing:

• Talk to a licensed agent familiar with PSHB

• Ask questions during Open Season

• Double-check plan specifics before enrolling

You don’t have to figure it out alone, and professional advice could save you from a year’s worth of enrollment regret.

Skipping the Annual Review

Even if you’re happy with your current PSHB plan, that doesn’t mean you can set it and forget it. Plan details can change every year—copays go up, formularies shift, provider networks change.

It’s worth doing a yearly checkup on your plan:

• Read the new plan brochure each Open Season

• Check if your doctors are still in-network

• Make sure your prescriptions are still covered affordably

A 30-minute review can spare you 12 months of headaches.

Make Smart PSHB Moves for 2025 and Beyond

The PSHB transition is a big deal, especially if you’re nearing retirement or already there. Avoiding these common mistakes can save you money, time, and stress down the road. It all comes down to preparation, knowing your options, and making informed choices.

If you’re feeling unsure, get in touch with a licensed agent listed on this website for help navigating your PSHB enrollment. A little guidance now could make a big difference in your benefits for years to come.