Key Takeaways

• If you’re Medicare-eligible and relying on PSHB in 2025, enrolling in Medicare Part B is not just a suggestion—it’s a requirement for most.

• Failing to enroll in Part B on time may leave you without prescription coverage and could disqualify you from your PSHB plan.

What PSHB Requires in 2025

The Postal Service Health Benefits (PSHB) Program became active in 2025, replacing FEHB for USPS employees and retirees. It brings with it a new set of rules, particularly for those aged 65 and older who are eligible for Medicare.

Under PSHB, Medicare integration is not optional for many enrollees. If you meet specific criteria and fail to enroll in Medicare Part B, you could lose access to important parts of your PSHB coverage, especially prescription drug benefits.

You need to understand the timeline, the consequences of inaction, and how the rules apply to you.

Who Must Enroll in Medicare Part B

You are required to enroll in Medicare Part B to maintain full PSHB coverage if you meet the following conditions:

• You are Medicare-eligible (generally age 65 or older), and

• You are a Postal retiree or family member of a retiree, and

• You retired after January 1, 2025, or

• You were an active employee aged 64 or older as of January 1, 2025.

Exemptions apply to:

• Those who retired on or before January 1, 2025, and were already Medicare-eligible but not enrolled in Part B.

• Those living abroad without access to Medicare.

• Certain individuals with Veterans Affairs (VA) or Indian Health Service coverage.

The Risk of Losing Drug Coverage

PSHB plans in 2025 automatically include Medicare Part D prescription drug coverage through an Employer Group Waiver Plan (EGWP). This is only available if you are enrolled in both the PSHB plan and Medicare Part B.

If you opt out of Medicare Part B:

• You will not be auto-enrolled in the Part D drug coverage through PSHB.

• You will lose prescription benefits under your PSHB plan.

• You may face limited re-enrollment options if you later decide to enroll in Part B.

This means your access to affordable medications could be severely restricted.

What Happens If You Miss the Enrollment Deadline

Missing the required Part B enrollment when you’re first eligible can set off a series of complications:

• Late enrollment penalty: You could face a permanent surcharge on your monthly premium.

• Delayed coverage: Your PSHB plan may delay or deny services that rely on Medicare coordination.

• Disenrollment risks: You might be disenrolled from PSHB drug coverage.

In 2025, timely coordination between Medicare and PSHB is essential. The window for initial enrollment in Part B usually lasts 7 months: 3 months before, the month of, and 3 months after your 65th birthday. For those subject to mandatory enrollment under PSHB, this timeline becomes even more critical.

How Medicare and PSHB Work Together

When you enroll in Medicare Part B, your PSHB plan becomes secondary to Medicare. This coordination works in your favor:

• Medicare pays first for your medical expenses.

• PSHB pays second, covering deductibles, coinsurance, and other gaps.

• You often pay less out of pocket, especially if your PSHB plan offers Part B premium reimbursements or reduced cost-sharing.

This pairing improves coverage while reducing your personal costs—but only if you remain enrolled in both parts.

Why Part B Enrollment Protects Your Health and Finances

Here are a few reasons why failing to enroll in Medicare Part B while relying on PSHB could leave you vulnerable:

• Unexpected medical bills: Without Medicare as the primary payer, your PSHB plan may not fully cover hospital or outpatient services.

• Prescription gaps: Skipping Part B removes your eligibility for the integrated drug coverage.

• Loss of coordinated benefits: Some PSHB plans waive deductibles or copays when Part B is in effect—you forfeit these advantages without enrollment.

What You Pay in 2025

The standard Medicare Part B premium in 2025 is $185 per month, with a deductible of $257. These figures may be higher if your income exceeds the IRMAA thresholds ($106,000 for individuals and $212,000 for couples filing jointly).

While that cost may seem steep, PSHB plans often provide financial offsets:

• Some plans reimburse part or all of your Part B premium.

• You could see reduced copays, waived deductibles, or lower out-of-pocket maximums.

The net effect? Enrolling in Part B may save you money overall.

Mistakes to Avoid

There are a few common errors that can cause serious issues:

• Assuming your PSHB plan covers everything: In 2025, most plans coordinate with Medicare and expect you to have Part B.

• Delaying enrollment to save money: This can backfire due to penalties and coverage gaps.

• Not reading the fine print: Your plan brochure outlines specific requirements for Medicare-eligible members.

• Failing to act during a Special Enrollment Period: If you missed your Initial Enrollment Period but qualify for a Special Enrollment Period (e.g., coming off active employment), act quickly.

What If You’re Not Yet 65?

If you’re under 65 and not yet Medicare-eligible, your PSHB coverage works much like FEHB did. However, once you turn 65, your status changes. You’ll receive a notice about Medicare eligibility, and that’s your cue to:

• Enroll in Medicare Part A (usually premium-free).

• Enroll in Medicare Part B if you’re subject to the PSHB requirement.

Failing to prepare ahead of time means risking higher costs and fewer coverage options later.

Retiree-Specific Considerations

If you’re a Postal retiree or annuitant, understanding your Medicare status is non-negotiable:

• Your eligibility date for Medicare may not align exactly with your retirement date.

• Your PSHB enrollment must match your Medicare enrollment status to maintain full benefits.

• Some annuitants assume that enrolling in Medicare later will improve savings—in most PSHB cases, that’s false.

You’ll want to plan early, review your plan materials, and speak with a licensed agent listed on this website to review your options.

How to Check Your Medicare Requirement Status

To find out if you’re subject to the Medicare Part B enrollment requirement:

• Check your retirement date.

• Review your age as of January 1, 2025.

• Look at your Medicare eligibility status.

• Refer to communications sent by OPM, LiteBlue, or KeepingPosted.org.

If you’re unsure, consult a licensed agent for guidance tailored to your case.

Preparing for Enrollment

If you’re approaching Medicare eligibility, here’s what you should do in advance:

• Set a calendar reminder for your Initial Enrollment Period.

• Collect required documents (e.g., proof of age, SSN, prior employment).

• Understand your PSHB plan’s expectations for Medicare coordination.

• Contact your local Social Security office for Part B enrollment.

Acting early prevents penalties and ensures your PSHB plan continues without disruption.

Protecting Your Future With Informed Choices

Relying on PSHB without Medicare Part B in 2025 is a risky strategy that could lead to significant coverage gaps and out-of-pocket costs. The system is designed for Medicare to serve as your primary insurance once you become eligible, with PSHB picking up the rest. Trying to bypass that framework can leave you underinsured.

Get the full value from your PSHB plan by understanding when and why you must enroll in Medicare Part B. If you’re uncertain about your situation or need help planning your next steps, reach out to a licensed agent listed on this website for one-on-one assistance.