Key Takeaways

• The PSHB program in 2025 introduces network differences that may limit access to your current doctor or specialist compared to FEHB.

• Understanding provider participation and plan network rules is essential before finalizing your PSHB selection, especially if you rely on continuous care.

A New Era of Postal Health Coverage—But Not Without Consequences

The launch of the Postal Service Health Benefits (PSHB) Program in 2025 replaces the long-standing FEHB coverage for postal retirees and employees. While many see the transition as a routine administrative update, it brings significant shifts that you can’t afford to overlook—especially when it comes to your ability to continue seeing your preferred doctors.

The provider access differences between PSHB and FEHB may seem minor at first glance, but they can have lasting effects on your continuity of care, specialist referrals, and even emergency services.

What Makes PSHB Networks Different from FEHB?

Under FEHB, you had access to a wide range of national provider networks. Many plans partnered with multiple large provider networks, giving you flexibility when traveling, relocating, or simply trying to find a nearby provider.

The PSHB structure, by contrast, places a stronger emphasis on postal-specific health plans that may operate with narrower networks. Here’s how that affects you:

• Fewer participating doctors and specialists in certain regions

• Increased importance of staying in-network to avoid higher out-of-pocket costs

• Potential disruption in ongoing care if your current doctor isn’t in the PSHB plan’s network

Why Your Doctor Might Not Be Covered Anymore

The fact that your provider accepted your FEHB plan in 2024 doesn’t guarantee they will accept your PSHB plan in 2025. Providers often negotiate separate agreements with each network. As new contracts form under the PSHB structure, some doctors and clinics may opt not to participate.

Key reasons for this include:

• Changes in reimbursement rates or administrative requirements

• Shift in insurer relationships due to the federal restructuring

• Geographic limitations in PSHB plan networks compared to broader FEHB networks

You may find that:

• Your doctor isn’t accepting any PSHB plan.

• Your doctor accepts one PSHB plan but not others.

• Your current provider is now considered out-of-network, resulting in higher copayments or coinsurance.

In-Network vs. Out-of-Network: What’s the Real Cost?

In PSHB plans, just like in FEHB, the cost difference between in-network and out-of-network care can be dramatic. But because some PSHB plans operate on smaller or regional networks, you may unknowingly shift more of your care to the out-of-network category unless you carefully confirm provider participation.

Here’s how that could affect you:

• Primary care copayments could double or triple out-of-network.

• Specialist visits may require coinsurance instead of a flat copay.

• Deductibles are usually much higher out-of-network.

• You might be billed for the difference between what the provider charges and what the plan pays.

Specialist Access and Referral Rules

One subtle but impactful change is how specialist referrals are handled. In some PSHB plans, stricter referral requirements now apply. That means:

• You might need a referral from a primary care physician (PCP) before seeing a specialist.

• Some services require prior authorization even if they didn’t under FEHB.

• A delay in getting these approvals can result in postponed treatments.

This creates potential barriers if you’re managing chronic conditions, undergoing regular treatments, or relying on a team of providers.

Geographic Disparities in Provider Networks

The PSHB plans for 2025 are not equally robust in every region. While some urban areas may have broad provider participation, rural regions could see limited options. This uneven distribution can make it harder to:

• Find a participating primary care provider nearby

• Continue treatment with a local specialist

• Get access to in-network urgent care or mental health services

Even if you are satisfied with your current provider, moving or retiring in another state could change your access.

Emergency and Urgent Care Access

You are still covered in emergencies no matter where you go, whether in or out-of-network. However, the definition of an emergency matters. If a service is deemed non-emergent, even in a hospital setting, and is rendered by an out-of-network provider, you may end up with a large bill.

Urgent care access varies by plan:

• Some plans restrict urgent care to specific chains or facilities.

• Others require calling a nurse hotline before visiting.

• In less populated regions, finding an in-network urgent care center could involve longer travel.

What You Can Do to Protect Your Provider Access

To ensure you retain access to your current providers under the PSHB system, here are a few proactive steps:

• Confirm network participation: Don’t assume your doctor is in-network—call and verify directly.

• Use OPM’s tools and plan brochures: Search specifically for doctors, clinics, or hospitals by zip code.

• Check for Medicare coordination: If you’re 65 or older, verify whether your PSHB plan coordinates with Medicare Part B and how that affects provider access.

• Request a transition of care: Some plans may temporarily allow out-of-network providers if you’re in the middle of treatment.

Don’t Confuse Similar Names With Similar Networks

Several PSHB plans may carry names that sound like their FEHB counterparts. But their networks, cost structures, and even coverage rules may have changed significantly. Just because the name stayed the same doesn’t mean your doctor list did.

• Compare both the 2024 FEHB and 2025 PSHB brochures side by side.

• Search for provider directories separately for each plan.

• Don’t rely on past assumptions—ask for updated information.

Medicare Coordination Matters

For annuitants aged 65 and older, Medicare enrollment is often tied to your PSHB eligibility. Most Medicare-eligible enrollees must be enrolled in Medicare Part B to remain in PSHB. This has added layers of complexity to how provider access works:

• Some PSHB plans waive deductibles and copays if Medicare is primary.

• Others have expanded networks for Medicare-eligible members.

• Failing to enroll in Part B when required could reduce your provider access significantly.

Timeline for Making Changes

You can only make changes to your PSHB plan during the annual Open Season, which runs from November to December. Outside of this period, changes are allowed only during qualifying life events (QLEs). For most retirees, your initial auto-enrollment in PSHB took place in late 2024.

Here’s what to do next:

• Review your plan materials immediately.

• Use this time to compare networks, especially if your provider is essential to your ongoing care.

• Make changes during Open Season if you discover access issues.

Your Health, Your Choice: Make Sure You’re Covered Where It Counts

You’ve spent a career earning your postal retirement benefits—don’t let something as avoidable as a network mismatch disrupt your healthcare access. Take time to check provider directories, confirm Medicare requirements, and understand how each PSHB plan may differ.

If you’re unsure whether your current doctors are in-network, or if the plan matches your needs, speak with a licensed agent listed on this website. Their insight could be the difference between uninterrupted care and unexpected medical expenses.