Key Takeaways

• In 2025, many PSHB plans carry deductibles between $350 and $2,000, depending on the type of plan and whether you use in-network or out-of-network services. You pay this amount before most benefits even start.

• Even common care like labs, scans, or outpatient visits can hit you with the full pre-deductible cost, making early-year care surprisingly expensive if you haven’t met your deductible.

What Deductibles Actually Mean for You in 2025

If you’re enrolled in a Postal Service Health Benefits (PSHB) plan in 2025, there’s a good chance you’ve seen the term “deductible” listed on your plan brochure. It might look like a simple figure: $500, $1,500, or even $2,000. But that number isn’t just a background figure. It’s the amount you must pay out-of-pocket before your plan starts sharing most of your costs.

And in 2025, that figure is more important than ever. As PSHB plans shift under the new system, the way deductibles work and when they apply can catch you off guard.

Why Deductibles Are Front-Loaded Costs

A deductible is not spread across your healthcare visits throughout the year. It applies first. That means:

• You pay the full price of many services early in the year until your deductible is met.

• Preventive care (like annual check-ups) is often covered before the deductible, but diagnostic services, labs, and urgent care visits may not be.

• Until you hit that deductible, your plan’s cost-sharing features like coinsurance and copayments might not even apply.

So if your deductible is $1,500 and you have a procedure in January costing $1,200, you may owe the full $1,200 out of pocket.

2025 Deductible Ranges Across PSHB

In 2025, PSHB plans typically fall into two categories:

• Low-deductible plans: These often have an in-network deductible between $350 and $500.

• High-deductible plans (HDHPs): These can carry deductibles from $1,500 to $2,000 or more.

Out-of-network deductibles are significantly higher, ranging from $1,000 to $3,000 depending on the plan.

If you’re a Self Plus One or Self and Family enrollee, these deductible amounts often apply to the entire family unit, meaning one person may have to meet an individual deductible, or the family as a whole needs to meet a combined deductible.

You Don’t Meet Your Deductible as Quickly as You Think

Here’s what surprises most people: hitting your deductible is harder than it seems. Even if you use healthcare regularly, the types of services you’re using might not count as much as you expect.

Some expenses that might not count toward your deductible include:

• Copayments for office visits

• Prescription costs if your plan uses a separate pharmacy deductible

• Services denied due to lack of prior authorization

Additionally, using providers who are out of network could mean their charges don’t count toward your in-network deductible at all.

How Deductibles Affect medicare-Eligible Annuitants

If you’re a Medicare-eligible annuitant enrolled in both PSHB and Medicare Part B, your deductible picture could look very different in 2025.

Here’s how:

• Many PSHB plans coordinate benefits with Medicare, meaning Medicare pays first.

• As a result, your PSHB deductible may not apply to most services covered by Medicare.

• Some plans even waive the deductible entirely if you are enrolled in Medicare Part B.

Still, this coordination only works if you are actively enrolled in both Medicare Part B and a PSHB plan that integrates well with it.

Deductibles vs. Copayments and Coinsurance

It’s easy to confuse deductibles with other out-of-pocket costs, so here’s how they differ:

• Deductible: What you pay first, before your plan pays most of your claims.

• Copayment: A flat fee (like $30 or $40) you pay per visit or prescription.

• Coinsurance: A percentage of the bill you pay after meeting the deductible (like 20%).

Some services have a copayment that applies regardless of the deductible, but others—especially higher-cost procedures—require you to pay toward your deductible first.

The Annual Reset You Can’t Ignore

Deductibles in PSHB plans reset every January 1. That means even if you reached your deductible last year in October or December, you start again from zero on January 1, 2025.

This is important to remember if you:

• Have planned surgeries or treatments early in the year

• Use ongoing services like physical therapy

• Are budgeting healthcare expenses by calendar year

Your first healthcare event of the year is often the most expensive if it occurs before you meet your deductible.

Out-of-Network? Prepare for Higher Deductibles

One of the most expensive mistakes you can make under PSHB in 2025 is going out-of-network without realizing it. In-network services are almost always cheaper and count toward a lower deductible.

With out-of-network care:

• The deductible is often double or triple the in-network amount

• Some services might not be covered at all

• Balance billing may occur, meaning you pay the difference between provider charges and plan reimbursement

Always check your provider’s network status before any appointment or procedure.

Do Deductibles Apply to Prescriptions?

That depends. Some PSHB plans have a combined deductible (medical and pharmacy), while others have a separate pharmacy deductible or no pharmacy deductible at all.

In 2025:

• Most high-deductible plans require you to meet the full deductible before prescription coverage kicks in

• Some plans exclude Tier 1 generics from the deductible

• Medicare-eligible annuitants with Part D drug coverage through PSHB may see drug costs that are already capped and don’t count toward the medical deductible

Carefully reviewing the summary of benefits can help you understand which prescription drugs apply toward your deductible.

How to Plan for Deductible Spending

Deductibles can feel like a financial ambush if you’re unprepared. Here are a few strategies to manage it:

• Use an FSA or HSA: If eligible, these accounts let you set aside pre-tax dollars for deductible expenses.

• Schedule care strategically: If you know you’ll need multiple services, consider grouping them in the same calendar year to reach your deductible sooner.

• Check for Medicare integration: If you’re a retiree with Medicare, confirm whether your plan waives or reduces deductibles.

• Always stay in network: This reduces both your deductible and your overall cost exposure.

Is the Deductible Worth the Premium Savings?

Some PSHB enrollees choose high-deductible plans because they offer lower monthly premiums. But those savings only pay off if you remain relatively healthy and don’t need frequent care.

Before opting for a lower-premium, high-deductible plan, ask yourself:

• Can I afford to pay $1,500 to $2,000 out-of-pocket early in the year?

• Do I anticipate needing surgeries, scans, or ongoing specialist care?

• Will I be coordinating with Medicare Part B?

Sometimes the lower premium isn’t worth the upfront deductible burden if you need moderate or high levels of care.

Understanding Your Plan’s Out-of-Pocket Maximum

The deductible is just one part of your total out-of-pocket exposure. In 2025, PSHB plans must cap your annual in-network out-of-pocket costs at:

• $7,500 for Self Only

• $15,000 for Self Plus One and Self and Family

Once you hit that cap, the plan pays 100% of eligible in-network costs. But that’s a high threshold, and the deductible is what gets you started on the path toward that limit.

What Happens If You Switch Plans Mid-Year?

If you experience a qualifying life event and switch PSHB plans mid-year, you should know:

• Deductibles do not transfer between plans

• You start over at $0 with the new plan’s deductible

• Any amounts paid toward your old deductible are not credited

This can be especially important for retirees who enroll in Medicare mid-year and want to shift to a Medicare-coordinated PSHB plan.

Why You Need to Rethink Deductibles in 2025

The shift to PSHB in 2025 is not just a change in name. It introduces new cost-sharing rules, different coordination with Medicare, and plan designs that put more weight on deductibles than many enrollees are used to.

You can no longer afford to treat the deductible as an afterthought. It is often your first financial hurdle in the healthcare system.

Get Help Comparing Deductibles and Plan Features

It’s critical to look beyond just premiums. The deductible, out-of-pocket maximum, coinsurance, copayments, and Medicare coordination all shape your true cost.

If you’re unsure which PSHB plan structure fits your medical and financial situation, get in touch with a licensed agent listed on this website. They can walk you through:

• How deductibles differ between plan options

• Whether your doctors are in network

• How Medicare enrollment changes your plan’s rules

• What to expect in out-of-pocket costs for your typical care