Key Takeaways

• Tracking your Postal Service Health Benefits (PSHB) costs and contributions in 2025 is critical for staying within your healthcare budget and avoiding financial surprises.

• Even predictable expenses like premiums can mask additional hidden or recurring costs, such as copayments, deductibles, and coinsurance that accumulate over the course of the year.

Why Paying Attention to Your PSHB Costs Matters in 2025

When you first enrolled in your Postal Service Health Benefits (PSHB) plan, you likely focused on choosing a premium that seemed affordable. But if that’s where your attention stopped, you might already be missing crucial parts of the financial picture. In 2025, health-related expenses continue to rise, and failing to keep an eye on your actual out-of-pocket costs can create budget shortfalls, stress, or even delays in getting care.

PSHB plans involve a combination of fixed contributions and variable costs. And while your monthly premium may seem straightforward, it is only one part of a much larger equation.

What You’re Paying For Every Month

You likely see the deduction for your PSHB premium each month and assume that covers most of your health costs. But that deduction only pays for a portion of the total plan cost. In 2025, the government still contributes about 70% of the total premium. You pay the remaining 30%, which varies depending on your plan type:

• Self Only

• Self Plus One

• Self and Family

But that’s just the premium. Beyond this, you may be paying hundreds more throughout the year in:

• Copayments (every time you visit a doctor or specialist)

• Coinsurance (your percentage of certain service costs)

• Deductibles (what you must pay before coverage kicks in)

• Out-of-network charges (if applicable)

The Accumulating Cost of Copayments

Copayments seem manageable in isolation. A $30 fee here, a $40 visit there. But over time, especially if you or your dependents see doctors frequently, those charges quickly add up. This is especially true if you have recurring appointments with specialists, physical therapy sessions, or frequent urgent care visits.

Even if you never reach your annual deductible or out-of-pocket maximum, you could still spend thousands a year on copayments alone. In many PSHB plans, copays are required for:

• Primary care and specialist visits

• Urgent care and emergency room visits

• Mental health or behavioral health services

• Prescription medications (especially non-preferred or specialty drugs)

When Coinsurance Kicks In

After you’ve met your deductible, coinsurance begins. This is the portion of a covered service you must pay, and it varies by service type and provider network. In 2025, typical coinsurance for in-network care ranges from 10% to 30% depending on the service, while out-of-network care may cost you 40% or more.

Coinsurance usually applies to:

• Hospitalizations

• Outpatient surgery

• Advanced imaging (MRI, CT scans)

• Durable medical equipment (DME)

The problem with coinsurance is that you often don’t know the actual amount until after the bill arrives. That uncertainty makes it harder to plan or track.

Deductibles and Your Annual Financial Risk

Your deductible is the amount you must pay before your plan begins to cover many services. Depending on the type of PSHB plan you have, your in-network deductible could range from several hundred to a couple thousand dollars.

For example:

• Low-deductible plans may start around $350-$600 for Self Only.

• High-deductible plans can go up to $1,500 or more.

In 2025, once you meet this amount, your coinsurance rate takes over for many services. But until that point, you pay in full for most care.

It’s crucial to understand when your deductible resets. Most PSHB plans reset on January 1, so expenses you pay late in the year might only help you for a few weeks unless you continue care into the next year.

Out-of-Pocket Maximums Are a Safety Net—But a High One

The out-of-pocket maximum (OOPM) is the cap on what you’ll pay in a given year for covered services. In-network OOPMs in PSHB plans can be as high as $7,500 for Self Only and $15,000 for Self Plus One or Self and Family.

Once you hit this limit, your plan pays 100% of covered costs for the rest of the year. However, many enrollees never reach this threshold because they:

• Avoid expensive treatments

• Delay elective care

• Are unaware of how close they are to the limit

Tracking this amount throughout the year can help you make better healthcare decisions. If you’re close to reaching the limit mid-year, it may be worth scheduling any remaining needed care before the reset.

Tracking Tools and Habits to Adopt in 2025

Staying on top of your health costs doesn’t have to be difficult, but it does require consistency. Here are a few practical steps to build awareness and control over your PSHB-related spending:

• Review monthly paystubs or retirement statements to see exact premium deductions.

• Log every copay and coinsurance payment in a spreadsheet or budgeting app.

• Request Explanation of Benefits (EOB) statements from your plan for every service.

• Check your deductible and OOPM status through your plan’s website or mobile portal.

• Review your plan brochure annually to stay informed of any changes.

When you make this a monthly habit, you can course-correct before overspending becomes a problem.

The Hidden Costs of Not Paying Attention

Failing to track your costs doesn’t just make you financially vulnerable—it can also lead to gaps in coverage or delays in care. Some of the risks include:

• Overpaying for services because you went out-of-network without realizing it.

• Missing out on preventive care you already pay for in your premium.

• Delaying necessary treatment because you underestimated your costs.

• Blowing your annual budget due to accumulated charges that seemed small at first.

This is especially risky for families or retirees on fixed incomes. Every dollar counts, and assumptions about coverage can lead to costly mistakes.

Common Misunderstandings That Cost You

Many PSHB enrollees still assume that their premiums cover most of their costs—or they may think once they hit their deductible, everything else is free. Unfortunately, those assumptions often lead to:

• Surprises when high coinsurance charges arrive

• Missed reimbursements due to outdated paperwork

• Late billing fees or collection risks from unpaid medical bills

Understanding your plan’s structure in detail matters more in 2025 than ever, especially as healthcare inflation continues and plan changes are more frequent.

What You Should Be Watching Closely This Year

In 2025, PSHB costs are affected by more than just personal usage. Inflation, provider contracts, and administrative updates can all lead to:

• Rising premiums in Open Season

• New copayment levels introduced annually

• Revised coinsurance percentages

• Changes to the pharmacy benefit structure

Make it a priority to evaluate these during the Open Season period each November and December. This is your window to make plan changes, switch coverage levels, or assess whether your current plan still fits your financial and medical needs.

Making Your Plan Work for You, Not Against You

Your PSHB plan should support your health, not undermine your financial security. To ensure this in 2025:

• Audit your 2024 expenses and compare them to your 2025 plan.

• Identify categories where you’re spending the most. Is it prescriptions, urgent care, or specialist visits?

• Weigh whether a plan with a higher premium but lower out-of-pocket costs might save you more in the long run.

• Reach out to plan representatives with questions before scheduling expensive procedures.

Being proactive doesn’t just save money—it improves your confidence in your coverage and reduces the stress of surprise bills.

Keep Your Eyes on the Details to Stay in Control

In 2025, small oversights in managing your PSHB expenses can have large consequences. The system isn’t always easy to follow, but staying aware of how much you’re paying—and why—is one of the most powerful tools you have.

You owe it to yourself to understand your costs, monitor your usage, and plan ahead. And if it ever feels overwhelming, you don’t have to figure it out alone. Speak with a licensed agent listed on the website for professional guidance that can help you make smarter decisions year after year.