Key Takeaways

• Even low copayments under Postal Service Health Benefits (PSHB) can snowball into significant annual expenses, especially when used frequently.

• Reviewing your plan’s copay structure in 2025 is essential for budgeting smartly and minimizing out-of-pocket surprises.

How Everyday Copayments Quietly Drain Your Budget

When you hear the word “copayment,” you might think of it as a minor, predictable part of your medical expenses. A small fee here, a manageable amount there. But when you’re enrolled in a Postal Service Health Benefits (PSHB) plan, these recurring charges can add up to much more than you’d expect.

Copayments are often flat amounts you pay when you visit a doctor, fill a prescription, or receive other health services. They sound harmless enough—but over a full year, they can become a budget-draining blind spot.

Let’s break down how this happens and what you can do about it in 2025.

What a Copayment Actually Covers

Under PSHB plans, a copayment usually applies when you:

• See a primary care physician or specialist

• Visit an urgent care clinic or emergency room

• Receive certain outpatient services

• Fill prescription medications

• Use diagnostic services like X-rays or lab work

These are fixed costs, meaning they don’t fluctuate based on your total medical bill. For example, you might pay a set amount every time you visit a specialist, regardless of whether the consultation costs $200 or $400.

The predictability seems helpful, but it hides a larger issue: frequency.

Frequency Turns Small Copays Into Big Numbers

A single visit or prescription refill may not be financially disruptive, but multiply those fees by the number of times you or a covered family member needs care in a year, and you’ll see how quickly the math changes:

• 3 urgent care visits = 3x copays

• 12 monthly prescription refills = 12x copays

• 4 physical therapy sessions = 4x copays

• 2 specialist visits = 2x copays

If you do the math based on common copayment ranges for 2025, it’s not hard to imagine spending hundreds—or even over a thousand—dollars annually in just flat fees.

Why Copayments Vary Within the Same Plan

Not all copayments are created equal. Within a single PSHB plan, your copay amount can differ based on:

• Type of service: Specialist visits cost more than primary care.

• Location of care: In-network care is cheaper than out-of-network.

• Type of medication: Generic drugs have lower copays than brand-name or specialty medications.

These cost distinctions are intentional—they guide enrollees toward more cost-efficient decisions. However, if you’re not closely tracking which services carry which costs, you can end up overpaying simply due to lack of awareness.

When Copays Start Before—and After—Your Deductible

One confusing part of copayments is how they interact with your deductible. Some services require you to meet a deductible before copayments kick in, while others charge a copay regardless of your deductible status.

For example:

• Preventive care often requires no copayment and is covered from day one.

• Non-preventive care may not apply copayments until your deductible is met.

• Urgent care or prescriptions often have immediate copays, deductible or not.

This blend of rules can be a financial trap if you’re not reviewing your plan brochure in detail each year.

High Utilizers Feel It the Most

If you or someone in your household manages a chronic condition, requires frequent physical therapy, or needs ongoing specialty medications, you likely already feel the burden of high copayments.

Unlike deductibles or coinsurance, which can be capped at your annual out-of-pocket maximum, copayments can often continue without limit for certain services, especially prescriptions. While your overall spending may eventually reach a cap, it may take months of consistent out-of-pocket spending to get there.

That means PSHB members who need consistent care might face uninterrupted monthly or weekly copayment costs.

Strategies to Reduce Your Copay Burden in 2025

1. Review and Compare During Open Season

Each PSHB plan has a different copay structure. Some have higher premiums but lower copays, while others offer low monthly costs but charge more per visit or prescription.

During the Open Season from November to December, take time to:

• Compare copay levels between plans

• Weigh premiums against expected usage

• Use OPM’s comparison tool for side-by-side evaluations

Choosing a plan with slightly higher premiums but lower copays may save money over the full year.

2. Switch to Generic Medications When Available

Generic medications often carry significantly lower copayments than brand-name drugs. Talk to your doctor or pharmacist to see if a generic equivalent is appropriate for your condition.

Over 12 months, switching just one medication to a generic can reduce your total copay costs considerably.

3. Consolidate Services When Possible

Some medical providers allow you to receive multiple services in one visit (e.g., check-up + lab work + prescription management). This can limit the number of separate copays you’re charged.

Before scheduling appointments, ask if services can be bundled to reduce your total number of copays.

4. Track Your Spending Monthly

Use a basic spreadsheet or budgeting app to log your monthly medical visits, prescriptions, and corresponding copays. Patterns will emerge quickly, allowing you to:

• Forecast your annual expenses more accurately

• Spot unnecessary or duplicate services

• Reevaluate your plan choice next Open Season with better data

Copayment Ranges Under PSHB Plans in 2025

Although the exact amounts vary, here’s what you might typically encounter this year:

These numbers help show just how easily monthly costs can grow depending on usage.

Watch for Copays That Don’t Count Toward Your Out-of-Pocket Maximum

Not every copayment counts toward your annual out-of-pocket maximum, especially for services like routine vision or dental care (unless you have integrated supplemental coverage).

This is an important distinction. If you’re budgeting based on the idea that your plan’s maximum will kick in and protect you eventually, double-check which costs apply to that limit and which do not.

Checklist: Avoiding a Copay Avalanche

Here’s a simple checklist to help keep your 2025 copayment costs under control:

Small Copays, Large Consequences

When you think of copayments as harmless amounts, it’s easy to overlook their collective impact. But under the PSHB system, especially in 2025, failing to account for their frequency and variability can create an unexpected strain on your healthcare budget.

Copays aren’t just about cost—they’re about predictability. And understanding where they fit in your overall healthcare strategy will help you make more informed decisions.

If you’re feeling unsure about how your plan’s copay structure is affecting your annual costs, reach out to a licensed agent listed on this website for professional help reviewing your options.