Key Takeaways

• Your default PSHB plan may not reflect your personal healthcare needs, retirement goals, or Medicare status.

• Taking time to review all available PSHB plans during Open Season can help you avoid higher costs and limited coverage.

Understanding the Default Enrollment Process

If you’re a United States Postal Service (USPS) employee or retiree, you’ve likely heard about the Postal Service Health Benefits (PSHB) Program that replaced your previous FEHB coverage starting January 1, 2025. What you may not realize is that unless you made a proactive choice during Open Season (which ran from November to December 2024), you were automatically enrolled in a default PSHB plan.

This default plan is based on your prior FEHB enrollment, and although it’s intended to be a smooth transition, it isn’t always the best fit. Your medical needs, financial situation, and Medicare status might demand a more customized option.

What Determines Your Default Plan?

The Office of Personnel Management (OPM) mapped your previous FEHB plan to the PSHB plan considered equivalent. But equivalence in plan names or coverage type doesn’t always mean equivalence in cost, benefits, or provider access.

Here’s what typically dictates your default:

• Your previous FEHB plan and enrollment type (Self Only, Self Plus One, or Self and Family)

• Whether you’re a current USPS employee or a retiree

• Your Medicare enrollment status, if applicable

This process may leave out crucial personal details—like whether your preferred doctors are still in-network, or if your new medication is covered. That’s why assuming the default is the best option can be risky.

Why the Default Plan Might Not Work for You

Several reasons can make your default PSHB plan less than ideal, especially if your healthcare circumstances have changed or if you are Medicare-eligible.

1. Cost Differences

Even if your plan name sounds familiar, the cost structure may have changed. PSHB plans are separate from FEHB plans, and premiums, copayments, deductibles, and coinsurance rates may differ significantly.

You might face:

• Higher monthly premiums than you paid under FEHB

• Deductibles or copays that weren’t part of your old plan

• Less favorable cost-sharing if you’re also enrolled in Medicare Part B

2. Medicare Integration Isn’t Always Optimal

If you are retired and enrolled in Medicare Part B, your PSHB plan should ideally integrate well with Medicare to reduce your out-of-pocket costs. But not every default plan offers that level of coordination.

Some PSHB plans waive or reduce deductibles and copays if you have Medicare. Others do not. If your default plan does not align with your Medicare coverage, you could be paying more than necessary.

3. Limited Provider Networks

Just because your former doctor accepted your FEHB plan doesn’t mean they participate in your PSHB plan. The provider network may have changed, especially for retirees who now rely more on local healthcare options.

If access to specific hospitals, specialists, or pharmacies is important to you, it’s essential to verify that your preferred providers are in-network under the new plan.

4. Changes in Prescription Drug Coverage

With the integration of Medicare Part D Employer Group Waiver Plans (EGWPs) into PSHB for Medicare-eligible annuitants, prescription drug benefits have shifted.

Default plans may offer:

• A $2,000 annual out-of-pocket cap under Part D

• A $35 monthly cap for insulin

• An expanded pharmacy network

However, if you opted out of the Medicare Part D integration or were enrolled in a plan that doesn’t work seamlessly with your prescriptions, you could lose coverage for some medications or pay higher costs.

5. You Missed Plan Enhancements or Reimbursements

Some PSHB plans offer additional perks to Medicare enrollees, such as partial reimbursement of Medicare Part B premiums or enhanced vision, dental, or hearing benefits.

If your default plan lacks these enhancements, you’re missing out on potential savings or extra coverage simply because you didn’t review your options.

How to Know if You’re in the Wrong Plan

Take a close look at your 2025 PSHB plan and ask yourself the following:

• Has your monthly premium increased compared to 2024?

• Are you seeing higher copays or deductibles?

• Do you struggle to find in-network providers?

• Have your prescription costs changed unexpectedly?

• Are you not receiving expected Medicare coordination benefits?

If you answered yes to any of these, it may be a sign that your default plan doesn’t align with your needs.

What You Can Do About It

Fortunately, you’re not locked in forever. Here’s how you can regain control of your healthcare coverage:

1. Mark Your Calendar for Open Season

The next Open Season runs from November to December 2025. During this time, you can switch plans, change enrollment types, or add eligible family members.

Even if you’re satisfied with your default plan now, reviewing your options each year ensures your plan continues to match your needs.

2. Research Your Plan Options

Before the next Open Season, use resources like:

• The OPM website

• KeepingPosted.org (for annuitants)

• LiteBlue (for employees)

• PSHB Navigator Helpline: 1-833-712-7742

These platforms help you compare plans side-by-side based on cost, benefits, and provider access.

3. Consider Your Medicare Enrollment

If you’re Medicare-eligible but haven’t enrolled in Part B yet, think about how this decision affects your PSHB coverage.

For most annuitants, enrolling in Medicare Part B can:

• Lower deductibles and copays in PSHB plans

• Provide access to drug coverage through EGWP

• Trigger eligibility for Medicare coordination perks

If you’re exempt from the Part B requirement (such as those who retired on or before January 1, 2025), you can still evaluate whether voluntary enrollment might improve your total coverage and reduce costs.

4. Get Help From a Licensed Agent

Healthcare decisions can be complex, especially with the transition from FEHB to PSHB. A licensed agent can provide personalized advice based on your Medicare status, location, and coverage needs.

Your Healthcare Plan Should Work for You

Relying on your default PSHB plan may feel convenient, but convenience shouldn’t come at the expense of cost or coverage. What worked in 2024 might not be right for your health situation in 2025.

The key takeaway here is simple: evaluate, compare, and adjust. Don’t assume the automatic choice is the right one. Take charge of your coverage and make changes during Open Season if necessary.

If you’re unsure about your current plan or want help reviewing your options, speak to a licensed agent listed on this website to get professional advice tailored to your needs.