Key Takeaways

• Coinsurance often has a bigger impact on your total PSHB health spending in 2026 than monthly premiums, especially when you use care frequently.

• Understanding how coinsurance works alongside deductibles and out-of-pocket limits helps you better estimate real annual costs under PSHB coverage.

Understanding How PSHB Costs Really Add Up

When you review your Postal Service Health Benefits (PSHB) options for 2026, it is easy to focus first on premiums. Premiums feel predictable because you pay them every month, whether you use care or not. Coinsurance works differently. It only appears after you receive medical services, yet it often determines how much you ultimately pay in a year.

PSHB plans in 2026 continue to combine premiums, deductibles, copayments, and coinsurance. While premiums set a baseline cost, coinsurance can quietly outweigh them when medical needs increase. Knowing how this cost-sharing structure works helps you see the full financial picture.

What Coinsurance Means Inside PSHB Coverage

Coinsurance is the percentage of covered medical costs you are responsible for paying after you meet your deductible. Instead of a fixed dollar amount, your share rises as the total cost of care rises.

In PSHB plans for 2026, coinsurance commonly applies to:

• Inpatient hospital services

• Outpatient procedures

• Diagnostic testing

• Certain specialist services

Because coinsurance is tied to the total allowed charge, it can grow quickly during periods of frequent or complex care.

Why Premiums Feel Important But Can Be Misleading

Premiums are easy to compare because they are listed clearly and paid on a set schedule. However, premiums represent only one part of total annual health spending.

You pay premiums regardless of whether you use medical services. Coinsurance, on the other hand, directly reflects how often and how extensively you use care. In years when you need more services, coinsurance can exceed what you pay in premiums over the same period.

This difference is especially relevant for PSHB members in 2026 who expect regular doctor visits, ongoing treatment, or hospital-based care.

How Deductibles Trigger Coinsurance Responsibilities

Before coinsurance applies, you must first meet your annual deductible. PSHB deductibles reset each year on January 1, 2026.

Once the deductible is met:

• Coinsurance percentages begin to apply to covered services

• Your share is calculated as a percentage of the plan’s allowed amount

• Higher-cost services result in higher out-of-pocket payments

This structure means that coinsurance costs tend to cluster later in the year, after deductibles are satisfied.

Why Coinsurance Can Overtake Premium Costs Over Time

Coinsurance often matters more than premiums because it has no fixed ceiling per service. As long as you continue to receive covered care, your percentage share continues to apply.

Several factors make coinsurance especially influential in 2026:

• Medical pricing continues to rise, increasing the base amount coinsurance is calculated on

• More services are delivered in outpatient hospital settings, which often involve higher allowed charges

• Extended treatment periods lead to repeated coinsurance payments

While premiums remain steady month to month, coinsurance expands alongside medical usage.

The Role Of Annual Out-Of-Pocket Limits

PSHB plans include annual out-of-pocket maximums that cap how much you pay for covered services in a calendar year. For 2026, these limits reset on January 1 and apply only to covered, in-network care.

Coinsurance counts toward these limits, while premiums do not. This distinction is important:

• Premiums continue even after you reach the out-of-pocket maximum

• Coinsurance stops once the limit is reached

• High coinsurance exposure can push you to the limit faster

Understanding this relationship helps you see how coinsurance shapes your worst-case spending scenario.

How Coinsurance Interacts With Copayments

PSHB plans often use a mix of copayments and coinsurance. Copayments are fixed dollar amounts, while coinsurance is percentage-based.

In many 2026 PSHB designs:

• Routine office visits may use copayments

• More complex services rely on coinsurance

• Coinsurance applies more often as care intensity increases

This structure shifts more financial responsibility to coinsurance during serious or ongoing medical needs.

Why Coinsurance Matters More For Frequent Care Users

If you use medical services regularly, coinsurance deserves close attention. Each service adds another percentage-based cost, which compounds over time.

Coinsurance tends to have greater impact when:

• Multiple services are delivered during the same episode of care

• Services involve facility-based charges

• Treatment spans several months within the same year

In these situations, the cumulative effect of coinsurance can surpass what you paid in premiums during the year.

Timing Of Costs During The 2026 Plan Year

Premiums are spread evenly throughout the year, but coinsurance often appears in concentrated periods. This timing difference can affect budgeting and cash flow.

In 2026:

• Deductibles reset in January

• Coinsurance becomes more visible after early-year services

• Late-year care may involve higher cumulative coinsurance totals

This uneven timing makes coinsurance feel more impactful, even if premiums remain unchanged.

Why Comparing Percentages Matters More Than Monthly Amounts

When reviewing PSHB options, it is tempting to prioritize lower premiums. However, small differences in coinsurance percentages can lead to large differences in total spending.

For example:

• A few percentage points apply to every covered charge

• Higher-cost services magnify percentage differences

• Repeated services multiply the impact

Focusing only on premiums may hide these long-term effects.

How Coinsurance Influences Long-Term Financial Planning

Coinsurance affects not just annual costs, but also how you plan for future healthcare needs. Because it scales with medical usage, it introduces uncertainty that premiums do not.

In 2026, careful planning means:

• Reviewing coinsurance percentages for major service categories

• Understanding how quickly costs could accumulate

• Considering how coinsurance fits within your overall retirement or household budget

This perspective helps you prepare for variability rather than fixed expenses alone.

What To Review During PSHB Open Season Decisions

When evaluating PSHB coverage, coinsurance deserves equal or greater attention than premiums. Key details to review include:

• Coinsurance percentages for inpatient and outpatient care

• How coinsurance applies after deductibles

• Annual out-of-pocket maximums and what counts toward them

Looking beyond premiums gives you a clearer view of potential total costs for 2026.

Bringing The Cost Picture Together

Premiums set the baseline for PSHB coverage, but coinsurance often determines how expensive your year becomes once care is needed. Because coinsurance rises with usage and applies to high-cost services, it frequently outweighs premium differences over time.

If you want help understanding how coinsurance, deductibles, and out-of-pocket limits may affect you in 2026, consider reaching out to one of the licensed agents listed on this website. They can help you review PSHB cost structures and explain how different elements work together based on your situation.