Key Takeaways

• Medicare Advantage (Part C) can offer you more coordinated care and lower out-of-pocket costs, but only if the plan aligns with your health needs, Medicare status, and PSHB requirements.

• Asking the right questions about networks, cost-sharing, and coordination with Medicare Part B is crucial before deciding if Part C is the right fit alongside your PSHB coverage.

Understanding What Medicare Advantage Really Is

Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Medicare benefits. Instead of getting coverage directly through Original Medicare (Parts A and B), you can choose to enroll in a Part C plan offered by a private plan that contracts with Medicare. These plans are required to provide the same benefits as Original Medicare but often include additional services like dental, vision, or hearing care.

For Postal Service Health Benefits (PSHB) enrollees, this means weighing whether a Part C plan will work well with your current or future health coverage. PSHB plans often coordinate with Medicare, but the addition of a Medicare Advantage plan can change how that coordination functions.

The First Question: Do You Meet the Requirements?

To enroll in Medicare Advantage, you must:

• Be enrolled in both Medicare Part A and Part B.

• Live in the plan’s service area.

• Not have End-Stage Renal Disease (with some exceptions).

If you’re a Postal retiree or nearing Medicare eligibility, PSHB requirements matter. As of 2025, many Medicare-eligible annuitants and family members must enroll in Medicare Part B to remain eligible for full PSHB benefits. Without Part B, a Part C plan is not even an option.

What Happens to Your PSHB Plan If You Enroll in Part C?

This is a major concern. PSHB coverage stays active even if you choose Medicare Advantage, but coordination between the two is not automatic or guaranteed. Here are key factors to examine:

• Some PSHB plans may offer wraparound benefits if you join Part C, while others might duplicate coverage.

• You’ll continue paying PSHB premiums, regardless of any Medicare Advantage enrollment.

• Not all PSHB plans will coordinate well with Part C, so you may lose out on potential cost-sharing savings if the two plans don’t align.

Check the Network Carefully

Medicare Advantage plans are typically network-based. You’ll need to ask:

• Is your primary doctor in the plan’s network?

• Are the specialists you currently see included?

• Are there geographic limits or referral requirements?

PSHB plans generally allow you to see any provider who accepts the plan, so if you’re used to that freedom, switching to a more restricted network under Part C might feel limiting.

What Are the Costs? (General, Not Specific)

Part C plans vary widely in how they handle cost-sharing. You may be responsible for:

• Copayments for doctor visits and services

• Coinsurance for hospital stays

• Deductibles that apply annually or per service

By contrast, PSHB plans generally have consistent copays and predictable out-of-pocket maximums. If you’re considering Part C, be sure to compare the general structure of costs to see if the Medicare Advantage plan actually reduces your overall expenses when combined with PSHB.

Do You Travel Often or Live in Multiple States?

This question is often overlooked. Many Medicare Advantage plans have limited service areas. If you:

• Live in one state part of the year and another during other months

• Travel often for extended periods

• Require care from providers in multiple regions

…then a traditional PSHB + Original Medicare pairing might offer you more flexibility than a Part C plan with a narrow provider network.

What Happens to Your Prescription Drug Coverage?

In 2025, if you’re Medicare-eligible and enrolled in PSHB, you automatically get drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP) linked to your PSHB plan. If you enroll in a standalone Medicare Advantage plan with its own drug benefit:

• You may be disenrolled from the PSHB prescription benefit.

• You may not be eligible to re-enroll in the EGWP until the next Open Season.

That means you need to look closely at how drug coverage will work. Does the Part C plan offer better access? Lower out-of-pocket spending? Or are you better served by staying within the PSHB system for prescriptions?

How Will Care Be Coordinated?

One advantage of many Medicare Advantage plans is that they coordinate your care more actively than Original Medicare. This may include:

• Managing chronic conditions with a dedicated case manager

• Providing preventive care reminders

• Offering home health or telehealth services

PSHB plans may also provide care coordination, but not to the same degree. So if your health needs are complex, this could be a deciding factor in favor of Part C. But again, you must confirm if the coordination benefits justify any trade-offs in provider flexibility or added rules.

What Is the Risk of Surprise Costs?

Surprise costs can happen if you:

• Receive care out of network without prior authorization

• Use a service not covered by the Medicare Advantage plan

• Misunderstand plan limits on therapies, imaging, or durable medical equipment

With PSHB, coverage tends to be broader and more predictable. Part C plans sometimes use step therapy or prior authorization, which can delay or restrict care. Always review the plan documents carefully or speak with a licensed agent listed on this website to clarify potential hidden costs.

Do You Want Simpler or More Controlled Coverage?

This is a question of personal preference. Some people value the streamlined experience that Medicare Advantage offers:

• One ID card

• One plan administrator

• A single customer service number

Others may prefer the broader reach of Original Medicare combined with a PSHB plan. The trade-off is between convenience and flexibility.

When Can You Enroll or Change Your Mind?

Enrollment and changes are limited to specific periods. For Medicare Advantage in 2025:

• Initial Enrollment Period: When you first become eligible for Medicare, around age 65

• Annual Enrollment Period: October 15 to December 7

• Medicare Advantage Open Enrollment: January 1 to March 31 (if already enrolled in a Part C plan)

If you decide Part C isn’t the right fit, you must wait for the appropriate enrollment window to return to Original Medicare and your PSHB-only setup. Make sure you’re comfortable with the commitment before switching.

Does Your PSHB Plan Offer Incentives for Medicare Enrollment?

Some PSHB plans reward you for enrolling in both Medicare Parts A and B. These incentives might include:

• Lower copays or deductibles

• Part B premium reimbursement

• Expanded service access

But if you enroll in a separate Medicare Advantage plan, those incentives could disappear. Confirm with your PSHB plan whether any such rewards still apply if you choose Part C.

What About the Out-of-Pocket Limits?

In 2025, Medicare Advantage plans have a maximum out-of-pocket (MOOP) limit for in-network services set at $9,350. However, this number excludes many non-covered services and only applies to Medicare-covered benefits. Meanwhile, your PSHB plan likely has a lower MOOP and includes more services in that calculation.

If you keep both, you could be juggling two separate out-of-pocket structures. That makes it even more important to understand where each plan begins and ends in terms of responsibility.

Summary of What to Ask Before Signing Up

Here’s a quick list of key questions you should answer before choosing Medicare Advantage with PSHB:

• Are you enrolled in both Part A and B?

• Will your PSHB plan coordinate with the Part C plan?

• Is your current doctor in the network?

• Will you lose prescription drug benefits from PSHB?

• Are there extra costs or limitations hidden in the plan?

• Do you need broad geographic access to providers?

• Are the out-of-pocket costs acceptable when added to your PSHB premium?

Choosing Confidently with the Right Questions in Hand

Part C can offer real advantages—but it only works well if you fully understand the trade-offs, eligibility requirements, and coordination with your PSHB plan. Start with your Medicare status, follow up with provider network details, then review drug coverage, cost-sharing, and service area rules.

You don’t need to figure it out alone. For support evaluating your options or answering plan-specific questions, reach out to a licensed agent listed on this website. A clear, personalized review of your situation can prevent costly surprises and ensure your coverage supports both your health and your financial stability.