Key Takeaways

• Choosing a PSHB plan based solely on monthly premiums can lead to unexpected costs later. You need to examine the full cost picture, including deductibles, coinsurance, and Medicare coordination if you’re eligible.

• In 2025, many PSHB plans offer benefits that are only accessible or financially valuable if you’re enrolled in Medicare Part B. Your plan choice should account for how your medical needs and Medicare status align with specific plan benefits.

Why Price Alone Isn’t Enough

It’s tempting to focus only on monthly premium costs when evaluating Postal Service Health Benefits (PSHB) plans. After all, those numbers are clearly listed and easy to compare. But basing your choice on premiums alone can lead you into a plan that costs more over time, delivers fewer benefits, or doesn’t match your actual medical needs.

A low premium doesn’t always mean a good deal. In many cases, it may come with:

• Higher deductibles

• Larger out-of-pocket maximums

• Less generous cost-sharing for specialist visits or procedures

• Limited Medicare coordination features for those eligible

Understanding how your total healthcare spending can fluctuate based on these factors is crucial in 2025, especially since premiums and cost-sharing structures continue to evolve.

Understand the Full Cost Picture

Your total cost includes more than just your monthly premium. PSHB plans in 2025 have varying structures that directly impact your overall financial exposure.

Here’s what else to examine:

Deductibles

A lower-premium plan often means you’ll pay more upfront before your coverage kicks in. Deductibles for Self Only coverage in 2025 range widely—from under $500 to over $1,500, depending on the plan type.

Copayments and Coinsurance

Even after meeting your deductible, you’ll likely pay some form of:

• Copayments (fixed costs for services like $30 for a specialist visit)

• Coinsurance (a percentage, such as 20% of the total charge for a diagnostic procedure)

Plans with lower premiums often shift more of the financial burden here, which can add up significantly over the year.

Out-of-Pocket Maximums

This cap is the most you’ll pay in a calendar year for covered services. In-network maximums for Self Only in 2025 range from around $5,000 to $7,500, depending on the plan. For Self Plus One or Self and Family, they can be twice that.

If you experience a medical emergency, chronic illness, or just have multiple healthcare needs, the difference in these caps could have a major financial impact.

Medicare Coordination Can Change Everything

If you’re age 65 or older—or nearing it—don’t ignore how PSHB plans work with Medicare Part B. In 2025, certain plans provide benefits like:

• Waived or reduced deductibles when combined with Medicare

• Lower copayments

• Drug coverage under an integrated Medicare Part D Employer Group Waiver Plan (EGWP)

But here’s the catch: these savings only apply if you’re actually enrolled in Medicare Part B. Without that enrollment, you’ll miss out on many plan enhancements, and the total cost of care could be higher—even if your plan’s premium looks attractive at first.

Think Beyond the Doctor’s Office

Many PSHB members focus heavily on primary care and routine specialist visits when comparing plans. That’s important, but it’s just one piece of the equation.

Here are other services that vary widely across plans in 2025:

• Emergency room visits: Some plans charge a flat copay, others charge coinsurance based on the full ER bill.

• Urgent care: Similar services can have dramatically different out-of-pocket costs.

• Mental health services: Outpatient therapy, inpatient care, and prescription drugs can be covered very differently.

• Durable medical equipment (DME): This includes CPAP machines, walkers, and glucose monitors—critical for those with chronic conditions.

• Out-of-network costs: While many PSHB plans emphasize in-network care, occasional needs outside the network may arise. Out-of-network costs can be steep.

Understand Prescription Drug Coverage

All PSHB plans include pharmacy benefits, but not all coverage is equal.

For 2025, Medicare-eligible enrollees are automatically enrolled in an integrated Part D EGWP unless they opt out. This brings new features like:

• An annual $2,000 cap on out-of-pocket drug expenses

• Monthly payment option for spreading drug costs

• Access to a wider pharmacy network

However, for those not eligible for Medicare, drug costs depend on tiered formularies, prior authorizations, and mail-order options—each of which varies widely across plans.

So if prescriptions are a regular part of your healthcare, don’t assume all plans treat them the same. What you pay at the pharmacy counter may surprise you.

Consider Your Dependents’ Needs

If you’re enrolling in a Self Plus One or Self and Family plan, don’t forget that your family members may have different medical needs than you do.

Ask yourself:

• Are they Medicare-eligible too?

• Do they see different types of specialists?

• Will they need mental health services, pediatric care, or maternity coverage?

• Are they likely to use out-of-network services?

Plans may favor individual enrollees with Medicare, but not offer the same coordination for younger or non-Medicare family members. This imbalance can affect total household spending.

Use the PSHB Plan Comparison Tools Strategically

The Office of Personnel Management (OPM) provides plan comparison tools, but many users skim through them without fully leveraging the filters and side-by-side comparisons.

Here’s how to make the most of them:

• Filter by Medicare coordination if you’re eligible

• View plan brochures—not just summaries—for full terms

• Compare cost-sharing line-by-line (copayments, coinsurance, etc.)

• Download and review the Summary of Benefits and Coverage (SBC) to understand actual services and limitations

Don’t just compare two or three plans. In 2025, the PSHB program offers dozens of choices depending on your region. Taking time to explore all of them can help you spot better-fitting options.

Watch for Plan-Specific Enhancements

Some PSHB plans in 2025 offer additional wellness incentives or cost-saving perks, including:

• Health rewards for completing wellness assessments

• Discounted fitness programs or virtual fitness access

• Reimbursement for telehealth services

• Nurse hotlines or case management support for chronic illness

These aren’t dealbreakers, but they can enhance your experience and lower your costs. Just make sure they don’t distract you from more critical benefits like prescription drug coverage, provider access, or out-of-pocket caps.

Evaluate Provider Networks

No matter how attractive a plan seems on paper, it won’t be a good fit if your preferred doctors and hospitals aren’t in-network. In 2025, most PSHB plans include nationwide provider access, but some are regional or have tighter restrictions.

Take time to:

• Confirm in-network status for your primary doctor and specialists

• Check if your preferred hospital or clinic participates

• Ask whether your plan requires referrals to see specialists

Provider availability can make or break your experience with a PSHB plan, especially if you travel or split time between multiple states.

Be Prepared for Year-to-Year Changes

Just because a plan worked for you in 2024 doesn’t mean it will still be a good fit in 2025. PSHB plans update cost-sharing, networks, benefits, and Medicare coordination terms each year.

Before sticking with the same plan, check for:

• Changes in copayments or deductibles

• Updated provider networks

• Modifications in drug formularies

• New Medicare coordination rules or perks

Open Season from November to December is your annual opportunity to switch plans. Use that window to reevaluate your needs and make updates.

Choosing Based on the Full Picture Makes the Difference

Price is just one of many factors that define your experience with a PSHB plan. In 2025, successful plan selection means evaluating total costs, Medicare alignment, drug coverage, provider access, and unique household needs.

You don’t need to do this alone. Reach out to a licensed agent listed on this website who can help you understand your options, compare the details that matter, and avoid costly surprises.