Key Takeaways

• PSHB deductibles in 2025 are not always easy to locate or understand on plan brochures or summaries, which can lead to underestimating your total annual out-of-pocket costs.

• If you skip over deductible fine print or misunderstand how your deductible applies, you may find yourself paying hundreds or even thousands more than expected, especially early in the year.

Why Deductibles Still Matter in 2025

Under the Postal Service Health Benefits (PSHB) Program, deductibles play a critical role in shaping your out-of-pocket spending. While premiums may grab your attention first, deductibles directly affect how much you must pay before your plan begins covering certain medical services.

In 2025, deductibles are particularly important because many PSHB plans have updated or restructured their cost-sharing models. This includes shifting costs through higher deductibles or embedding them within other coverage layers. If you don’t examine the deductible section of your PSHB plan brochure carefully, you could miss major financial implications.

How PSHB Plans Present Deductibles

Deductibles are not always front and center. Here’s how they’re typically structured:

• In-network vs. out-of-network deductibles: Many PSHB plans have separate deductibles for care received from network providers versus those outside the network. Out-of-network deductibles are typically much higher.

• Self vs. family tiers: You’ll often see three tiers: Self Only, Self Plus One, and Self and Family. Each tier has its own deductible amount, and family deductibles may require each individual to meet a portion before full benefits apply.

• High-deductible vs. low-deductible plans: Some PSHB options are labeled as high-deductible plans, often paired with Health Savings Accounts (HSAs), while others offer more traditional structures. In either case, it’s not always obvious from the summary which category a plan falls into.

If your plan includes a $1,500 deductible but you miss that detail, you may face unexpected costs early in the plan year before coverage kicks in fully.

Where to Find Deductible Details

Finding deductible amounts isn’t always straightforward. In most cases, you’ll need to check:

• The official PSHB plan brochure from OPM, typically listed under the “Summary of Benefits” section.

• Detailed plan comparison tools available through PSHB enrollment websites.

• Cost-sharing charts, which may separate primary care visits, specialist visits, labs, and hospitalization with different rules tied to the deductible.

Unfortunately, these charts can span multiple pages and use fine print to explain when the deductible does or doesn’t apply.

Deductibles Can Be Hidden in Common Services

Even if your plan claims to offer “low out-of-pocket costs,” the deductible can still apply in ways that catch you off guard. Here’s where it may show up:

• Lab tests and diagnostic imaging: These may only be covered after your deductible is met, even if office visits have fixed copayments.

• Emergency room visits: Plans often apply the deductible to emergency care, especially if the visit results in hospital admission.

• Specialist visits: Certain specialist services might be subject to the deductible first, especially if the specialist is out of network.

• Brand-name prescriptions: If your plan wraps prescription drugs under the medical deductible, this can delay cost sharing until you’ve paid the deductible.

These nuances can result in significant out-of-pocket costs—especially in January and February when deductibles reset.

The Reset Date: Why January 1 Matters

Every PSHB plan resets its deductible annually on January 1, which can create a sharp rise in your medical bills early in the year if you require care right away.

Let’s say you used several medical services late in the previous year, and your plan covered nearly everything because your deductible had been met. Once the calendar flips to 2025, that deductible restarts—even if you are continuing treatment.

This can especially affect:

• Ongoing physical therapy

• Post-surgical follow-up

• Refills of costly medications

• Chronic condition monitoring

Be aware of this cycle, and plan accordingly. Early-year costs can feel more painful due to this hard reset.

Deductibles and Medicare Integration

For Medicare-eligible annuitants enrolled in PSHB, some plans reduce or waive deductibles if you are also enrolled in Medicare Part B. This is an essential point because your out-of-pocket responsibility can significantly drop once Medicare is in place.

However, not every PSHB plan offers the same coordination with Medicare. You need to check:

• Whether your deductible is waived or merely reduced

• If this benefit applies only to in-network providers

• How this integration is triggered (e.g., you may need to submit proof of Part B enrollment)

If you are retired and not yet enrolled in Medicare Part B, you may miss out on these deductible savings until you enroll. Given that Medicare eligibility typically begins at age 65, this can be a major consideration when evaluating your PSHB options.

Impact on Budget Planning

In 2025, with inflation affecting healthcare and general living expenses, your deductible can be the tipping point between an affordable health plan and one that strains your monthly finances.

Be cautious of assuming a plan with a lower premium will necessarily result in lower total costs. A plan with a higher premium may offer:

• Lower deductibles

• More generous first-dollar coverage (services covered without requiring the deductible)

• Better coordination with Medicare

Use your own past healthcare utilization as a benchmark when evaluating deductible amounts. If you expect regular care, a low-deductible plan—even with a higher monthly cost—may offer better value.

Deductible Differences Within the Same Plan Family

Many PSHB insurers offer multiple tiers within the same plan family—such as a standard, high option, or value tier. Don’t assume that because you’re familiar with one option, the deductible is similar across all.

Here’s what often changes:

• Deductible amount: The value or high-deductible option may be significantly higher.

• What counts toward the deductible: Some tiers may apply the deductible to more services than others.

• How family deductibles are structured: Some plans require each family member to meet an individual portion before family benefits apply.

Always review your specific option—not just the general plan name.

PSHB Deductibles vs. Other Federal Plans

If you were previously covered under the FEHB program before transitioning to PSHB, you may notice that deductible structures are more prominent and sometimes more aggressive in PSHB.

While FEHB plans varied widely, many offered relatively low deductibles or none at all for basic services. In contrast, PSHB plans in 2025 may:

• Emphasize cost-sharing through higher deductibles

• Require more services to apply toward the deductible before coinsurance kicks in

• Encourage Medicare integration by tying deductible relief to Medicare Part B enrollment

This shift underscores the importance of closely reading the deductible section each year during the Open Season from November to December.

How to Double-Check Before Enrollment

Before locking in your 2025 PSHB coverage, here’s how you can verify deductible details:

• Visit the OPM website and download the full brochure for your plan

• Use plan comparison tools that allow side-by-side deductible evaluation

• Contact the PSHB Navigator Help Line with specific questions about deductible applications

• Confirm how the deductible applies for Medicare-enrolled members if applicable

These steps can help ensure you choose a plan that aligns with your medical needs and financial comfort level.

Review Your Deductible Now to Avoid Financial Surprises

Your deductible is more than just a number—it’s a foundational piece of your 2025 PSHB coverage. If it’s buried in plan documents or described in vague terms, don’t assume it’s minor. A missed deductible detail could result in hundreds or thousands in unexpected costs.

Before the next Open Season or when evaluating coverage for an upcoming life change, take time to:

• Identify your plan’s exact deductible

• Understand when and how it applies

• Evaluate whether Medicare enrollment could improve your coverage

If you need help understanding or comparing deductibles, speak with a licensed agent listed on this website. They can walk you through the fine print and ensure your chosen PSHB plan supports—not surprises—your financial and health priorities.