Key Takeaways

• Many postal retirees are opting out of Medicare Advantage despite its extra perks due to limitations in access, provider restrictions, and lack of cost predictability.

• For PSHB enrollees, understanding how Medicare Advantage interacts with their benefits is crucial to making informed decisions that protect long-term care and financial stability.

The Appeal of Medicare Advantage: What’s Drawing People In

At first glance, Medicare Advantage seems like an attractive option. It offers added benefits beyond Original Medicare, such as dental, vision, and hearing coverage, along with care coordination and sometimes even reimbursement features.

In 2025, many PSHB enrollees see these extras and wonder if this is the smarter path forward. After all, who wouldn’t want more for what appears to be less?

• Supplemental benefits may look attractive on marketing materials

• Out-of-pocket limits can seem like financial protection

• Consolidated coverage may sound simpler

But once you look under the surface, especially as a retired postal worker with PSHB coverage, the picture starts to shift.

1. The Provider Network Shrinks—Fast

One of the first challenges many retirees encounter with Medicare Advantage is provider access. Unlike Original Medicare, which allows you to see nearly any doctor or specialist who accepts Medicare, most Medicare Advantage plans operate on restricted networks.

As a PSHB enrollee, you may find that:

• Your long-time physician no longer accepts your new plan

• Specialist referrals become necessary where they weren’t before

• Access to hospitals and skilled nursing facilities may be limited

This shift can be especially jarring if you’ve been used to the broad flexibility of FEHB or PSHB plans when combined with Original Medicare. Medicare Advantage doesn’t always maintain those same standards.

2. PSHB Integration Doesn’t Always Mesh

Starting in 2025, the Postal Service Health Benefits (PSHB) Program requires most Medicare-eligible annuitants and family members to enroll in Medicare Part B to keep their PSHB coverage. However, this integration doesn’t guarantee a smooth fit with Medicare Advantage.

Here’s why:

• PSHB plans are designed to work optimally with Original Medicare, not necessarily with Advantage plans

• Some PSHB benefits may be duplicated or sidelined under a Medicare Advantage plan

• Coordination of benefits can be less predictable and more administratively complex

What looks like simplification on paper often becomes a layered puzzle in real life.

3. Supplemental Extras Aren’t Always Worth the Trade-Off

Yes, Medicare Advantage plans advertise added services. But what’s not always mentioned is that those extras come with fine print:

• Dental or vision services might be capped annually or tied to narrow provider networks

• Over-the-counter allowances may sound generous but come with redemption limits and restrictions

• Many of the extras don’t apply to specialist care or chronic condition management

When you already have PSHB plus Medicare Part B, these supplemental benefits often don’t add meaningful value. Worse, they can give the illusion of coverage that isn’t there when you need it most.

4. Prior Authorizations Create Delays in Care

In Original Medicare and PSHB arrangements, access to care tends to be direct—if your doctor recommends it, it’s likely covered.

With Medicare Advantage, prior authorizations are commonly required for a wide range of services:

• MRIs and diagnostic tests

• Durable medical equipment

• Home health services

• Skilled nursing and rehabilitation stays

For postal retirees managing chronic conditions, waiting for these approvals can delay necessary treatment. This added step isn’t just inconvenient—it can affect health outcomes.

5. Annual Changes Make It Hard to Plan Ahead

PSHB plans have predictable structures. You know what your copays, coinsurance, and deductibles will be, and those terms are generally stable.

Medicare Advantage plans, on the other hand, may change annually. Even if the premium looks consistent (which, in 2025, cannot be trusted as a sole indicator), you’ll find that:

• Formularies (drug lists) may change

• Copays for common services may rise

• Doctor networks may shrink further

• Coverage areas might shift or be withdrawn

That kind of instability makes long-term financial planning difficult—especially when you rely on predictable care in retirement.

6. Out-of-Pocket Costs Are Often Higher Than Anticipated

Medicare Advantage plans tout annual out-of-pocket maximums, which should, in theory, protect you financially. However, in practice, many retirees find those limits are high and reached more quickly than expected.

In 2025:

• In-network maximums can reach over $9,000

• Out-of-network limits may be as high as $14,000

These costs apply in addition to Medicare Part B premiums and any PSHB premiums you pay. When you start comparing total healthcare costs—not just monthly premiums—it becomes clear why some postal retirees are walking away from Advantage plans.

7. Emergency and Out-of-State Coverage Isn’t Always Reliable

Retirees often travel or move seasonally. Under Original Medicare and PSHB, you retain access across the U.S.

But with Medicare Advantage, coverage is often geographically restricted. If you’re out of your plan’s service area, you may encounter:

• Emergency-only coverage

• No access to routine care unless pre-approved

• Out-of-network rates that don’t count toward your in-network maximum

For retirees hoping to maintain flexibility and freedom in retirement, this is a major limitation.

8. Enrollment and Disenrollment Are More Complicated Than You Think

With PSHB, changes can be made during Open Season or during a Qualifying Life Event. But Medicare Advantage comes with different rules:

• You can only switch plans during the Annual Enrollment Period (Oct 15 – Dec 7)

• If you want to return to Original Medicare, you may not get the same Medigap coverage as before

• PSHB plans aren’t obligated to coordinate with Medicare Advantage providers

These restrictions can trap you in a plan you no longer want—and the exit strategy might not restore what you gave up.

What PSHB Retirees Are Choosing Instead

For many in your position, sticking with Original Medicare plus PSHB coverage offers a more stable, straightforward experience. This combination provides:

• Broad provider access

• Fewer prior authorizations

• Predictable cost-sharing

• National portability

• Full PSHB benefits with better integration

In 2025, as PSHB becomes the new norm, the question isn’t whether Medicare Advantage offers extra perks. It’s whether those perks are truly compatible with your healthcare needs and financial expectations as a retired postal worker.

Making the Smart Move for Long-Term Peace of Mind

You’ve earned your retirement benefits through years of postal service. Now is not the time to gamble them on healthcare plans that change their terms annually or limit your provider access.

While Medicare Advantage may appeal on the surface, your deeper needs—stability, access, integration—often favor sticking with PSHB and Original Medicare. That route aligns with the structure of the new 2025 PSHB system and is more likely to preserve your health, peace of mind, and control over your care.

If you have any doubt about what’s best in your situation, don’t go it alone. Reach out to a licensed agent listed on this website who understands both PSHB and Medicare and can help you compare your choices clearly.