Key Takeaways

• Navigating your health coverage under the Postal Service Health Benefits (PSHB) Program in 2025 is crucial for maintaining comprehensive healthcare. Understanding enrollment, costs, and Medicare integration ensures you make informed choices.

• The PSHB Program includes new features and requirements, such as Medicare Part B enrollment for eligible annuitants. Staying updated and reviewing plan options during Open Season is essential.

Your Health, Your Choices: Understanding PSHB in 2025

As a USPS worker or retiree, your health benefits are undergoing a significant shift in 2025. The transition from the Federal Employees Health Benefits (FEHB) Program to the Postal Service Health Benefits (PSHB) Program introduces new plans and requirements designed exclusively for Postal Service employees, annuitants, and their families. Whether you’re actively working, retired, or part of an eligible family, navigating these changes can seem daunting. Let’s break it down so you can approach this year’s health coverage decisions with confidence.

What Is the PSHB Program?

The PSHB Program replaces FEHB for USPS employees, annuitants, and eligible family members. While similar in structure, PSHB plans are tailored to meet the specific needs of postal workers and retirees. Administered by the Office of Personnel Management (OPM), PSHB offers a range of plan options, but it also comes with key differences compared to FEHB.

Key Highlights:

• Targeted Coverage: Exclusively available to Postal Service employees, annuitants, and their families.

• Integrated with Medicare: Medicare-eligible enrollees benefit from prescription drug coverage under a Medicare Part D Employer Group Waiver Plan (EGWP).

• Similar Open Season: You can review and change plans during the same Open Season as federal employees, running annually from mid-November to mid-December.

Are You Automatically Enrolled?

For many USPS workers and annuitants, the transition to PSHB is seamless. If you were enrolled in an FEHB plan in 2024, you’re automatically placed into a corresponding PSHB plan. However, this automatic enrollment doesn’t mean you should skip reviewing your options. Plans may have new premiums, benefits, or networks that differ from what you’re used to.

Take Action If:

• You want to switch to a different PSHB plan.

• Your current plan’s coverage no longer fits your needs.

• You’re newly eligible for Medicare and need to coordinate coverage.

The Role of Medicare in PSHB

Medicare integration plays a central role in the PSHB Program. If you’re a Medicare-eligible annuitant or family member, you must enroll in Medicare Part B to maintain PSHB coverage. This rule applies unless you retired on or before January 1, 2025, or meet specific exemption criteria.

Benefits of Enrolling in Part B:

• Enhanced Coordination: Medicare Part B pairs with your PSHB plan to reduce out-of-pocket costs.

• Prescription Savings: Automatic enrollment in a Medicare Part D EGWP ensures you get comprehensive drug coverage.

• Reimbursements: Many PSHB plans offer partial reimbursement for your Medicare Part B premiums.

Key Deadlines:

If you’re turning 65 this year, ensure you enroll in Medicare Part B during your Initial Enrollment Period (IEP) to avoid penalties. Missing this window can lead to higher costs and delayed coverage.

Costs You Need to Know

Health plan costs under PSHB include premiums, deductibles, copayments, and coinsurance. While exact amounts vary by plan, understanding general costs is vital.

Premium Contributions:

The Postal Service continues to cover a significant portion of your premiums, similar to FEHB. However, your share may vary based on the plan you choose and whether you coordinate with Medicare.

Deductibles and Out-of-Pocket Limits:

PSHB plans set annual deductibles and out-of-pocket maximums. For example:

• Deductible: This is the amount you pay before your plan starts covering most services.

• Out-of-Pocket Maximum: Once you reach this limit, your plan covers 100% of covered expenses for the rest of the year.

Cost Considerations:

Review the Summary of Benefits and Coverage (SBC) for each plan to understand what you’ll pay for services like doctor visits, hospital stays, and prescriptions.

Open Season: Your Window to Make Changes

Open Season is your annual opportunity to review and adjust your health coverage. For 2025, Open Season has already passed, but understanding the timeline helps you prepare for the next enrollment period.

What You Can Do During Open Season:

• Switch between PSHB plans.

• Add or remove family members from your coverage.

• Enroll in Medicare Part B if you’re newly eligible.

Qualifying Life Events (QLEs):

Outside Open Season, you can only change your plan if you experience a QLE, such as marriage, divorce, or the birth of a child.

Prescription Drug Coverage: A New Advantage

All Medicare-eligible PSHB enrollees automatically receive prescription drug coverage through a Medicare Part D EGWP. This change simplifies your pharmacy experience while providing cost-saving opportunities.

Features to Know:

• Comprehensive Coverage: Covers both generic and brand-name medications.

• $2,000 Out-of-Pocket Cap: Ensures you never pay more than this amount annually for prescriptions.

• Payment Options: You can spread costs over the year with the Medicare Prescription Payment Plan.

Why You Should Review the Annual Notice of Change (ANOC)

Each year, your PSHB plan sends an ANOC detailing changes in premiums, benefits, and networks. Reviewing this document is essential to staying informed about your coverage.

Key Updates to Look For:

• Adjustments to premiums and cost-sharing.

• Changes in provider networks or covered medications.

• New supplemental benefits, such as dental or vision coverage.

Tips for Choosing the Right Plan

Selecting a PSHB plan involves balancing costs, benefits, and network access. Here’s how to make the best choice for your needs:

1. Assess Your Healthcare Needs:

• How often do you visit doctors or specialists?

• Do you require regular prescriptions?

• Are you managing chronic conditions?

2. Compare Plans Side-by-Side:

Use OPM’s plan comparison tool to evaluate premiums, deductibles, and out-of-pocket limits.

3. Factor in Medicare Coordination:

If you’re eligible for Medicare, prioritize plans that integrate smoothly with Medicare Part B and include EGWP benefits.

Avoiding Pitfalls and Common Missteps

Transitioning to a new health plan can lead to confusion. Here’s how to avoid common mistakes:

Forgetting to Enroll in Medicare Part B:

If you’re Medicare-eligible and don’t enroll in Part B, you risk losing PSHB coverage.

Ignoring the ANOC:

Plan changes can significantly impact your costs and coverage. Always read the ANOC carefully.

Waiting Too Long to Act:

Deadlines matter. Missing Open Season or your IEP for Medicare can result in penalties or limited options.

Staying Informed Beyond 2025

The healthcare landscape continues to evolve, and staying proactive ensures you’re always covered. Bookmark the OPM website and USPS HR portals for updates and resources.

What to Watch For:

• Annual changes to premiums, deductibles, and benefits.

• New Medicare policies affecting coordination with PSHB.

• Open Season announcements to review and adjust your coverage.

Making PSHB Work for You

Navigating health coverage under the PSHB Program doesn’t have to be overwhelming. By understanding the program’s structure, costs, and requirements, you can make informed decisions that support your health and financial well-being. Take advantage of plan features, Medicare integration, and cost-saving opportunities to get the most from your benefits.​​​​​​​