Key Takeaways

• Medicare Advantage plans change every year. You need to review more than just the premium or extra perks. Cost-sharing, provider access, and prescription coverage can all shift in ways that affect your care.

• As a Postal Service Health Benefits (PSHB) enrollee, your choices may look different now that Medicare Part B is often required for continued PSHB coverage. Don’t assume last year’s plan still fits your current needs.

Annual Plan Changes Are Not Optional—They’re Inevitable

Every fall, Medicare Advantage plans across the country submit updated benefit structures to Medicare for the following year. These changes go into effect January 1, 2025. This means your 2024 plan may now include higher copayments, new provider restrictions, or removed benefits—without you even realizing it until you try to use your coverage.

If you are a PSHB enrollee and eligible for Medicare, you are likely required to enroll in Medicare Part B in 2025 to keep your PSHB coverage. Your PSHB plan may be integrated with a Medicare Advantage plan. This makes it even more important to understand what changes might impact you.

What You Need to Review Each Year

Plan Benefit Changes

From October 15 to December 7 each year, Medicare Open Enrollment allows you to switch or stay in a Medicare Advantage plan. But don’t skip reviewing your plan’s Annual Notice of Change (ANOC). This document outlines:

• Increases in premiums or deductibles (general costs only)

• Changes in out-of-pocket maximums

• Adjustments in cost-sharing for services like doctor visits or hospital stays

• Coverage updates for dental, vision, hearing, or other extra benefits

PSHB plans integrated with Medicare may also include prescription drug coverage through a Part D Employer Group Waiver Plan (EGWP). If this is the case for you, review the changes in:

• Your drug formulary

• Tiered pricing (generic vs. brand name)

• Pharmacy network access

Provider Network Access

Medicare Advantage plans often rely on local networks. That means you may only be covered if you see a provider who is in-network. These networks can shrink or shift from one year to the next. Some specialists or clinics that were in-network in 2024 may not be in-network in 2025.

Before you re-enroll, check:

• Whether your primary care doctor and specialists are still in-network

• If your preferred hospital or urgent care is covered

• Whether telehealth access is still included or has new restrictions

Prior Authorization Requirements

One of the least visible but most disruptive changes each year involves prior authorizations. Many Medicare Advantage plans require pre-approval before you can:

• Schedule surgery

• Receive physical therapy

• Access certain high-cost medications

These rules change every year and may be more stringent in 2025. Even if you didn’t need prior authorization last year, that could change now. The process can delay care if you’re not aware until you need the service.

PSHB-Specific Considerations in 2025

Medicare Part B Is Now Essential

For most Postal Service annuitants and their covered family members who are eligible for Medicare in 2025, enrollment in Medicare Part B is now required to maintain PSHB coverage. If you haven’t yet enrolled in Part B, you may face penalties or even lose eligibility for your PSHB benefits.

Exceptions apply only to:

• Annuitants who retired on or before January 1, 2025 and are not enrolled in Medicare Part B

• Covered family members living abroad

• Veterans receiving care through the VA

• Members eligible for Indian Health Services

Medicare Integration Can Help—If You Understand It

Many PSHB plans offer better cost-sharing if you’re enrolled in Medicare Part B. This can mean:

• Lower deductibles

• Reduced copayments for office visits and hospital stays

• Waived coinsurance in some cases

However, these savings vary from plan to plan. Some PSHB plans will automatically enroll you into a Medicare Advantage model, while others offer coordination with Original Medicare.

Make sure you understand:

• Whether your PSHB plan in 2025 includes a Medicare Advantage structure

• How benefits are coordinated between Medicare and your PSHB plan

• What happens to your drug coverage if you opt out of Medicare Part B

Don’t Skip the Details in the Annual Notice of Change

Each fall, you will receive an ANOC letter that highlights the changes in your Medicare Advantage plan. Don’t discard it or assume it doesn’t matter. You should:

• Compare this year’s coverage with last year’s

• Look for new restrictions or exclusions

• Review how emergency or urgent care will be covered

For PSHB plans, these changes may be bundled into a single document outlining both your health and prescription drug benefits. It is critical to read this carefully before Open Season ends in December.

Watch the Part D Prescription Drug Changes

As of January 1, 2025, the out-of-pocket cap for prescription drugs under Medicare Part D is $2,000. That’s a major improvement over past years, eliminating the “donut hole.”

If your PSHB plan includes integrated drug coverage:

• You may already be enrolled in a Part D EGWP

• You should verify which drugs are still covered under your plan

• Some brand-name drugs may have moved to a higher tier, affecting your costs

Also, new in 2025 is the Medicare Prescription Payment Plan. This allows you to spread your out-of-pocket costs throughout the year. PSHB enrollees who are eligible may want to explore if their plan includes this feature.

Evaluate Your Total Health Budget, Not Just Premiums

It’s tempting to judge plans based on how much they take out of your monthly annuity. But premiums are only one part of the equation. Consider:

• Deductibles you must meet before benefits kick in

• Copayments for doctor visits and urgent care

• Coinsurance percentages for hospital stays or surgeries

• Maximum annual out-of-pocket limits

This is especially important if you have a chronic health condition or expect to need specialist care or medications. Even small changes in copays or tier placement can significantly affect your overall budget.

When to Make Changes

The Medicare Open Enrollment Period runs every year from October 15 through December 7. If you want to:

• Switch from one Medicare Advantage plan to another

• Return to Original Medicare

• Join a separate Part D plan (if eligible)

…you must do it during this time frame. Any changes take effect January 1 of the following year.

PSHB Open Season also runs from November to December. You may receive automatic re-enrollment, but that doesn’t mean you should avoid reviewing your options.

Staying Covered Means Staying Informed

In 2025, maintaining your PSHB coverage requires more than just paying your premium. It means:

• Keeping your Medicare Part B enrollment active

• Staying informed on changes in your Medicare Advantage benefits

• Comparing your current plan against other available options

Don’t rely on assumptions or last year’s experience. The rules and benefits change annually, and only you know what care you expect to need this year.

A Smarter Way to Re-Enroll for 2025

Before you make a decision:

• Review your ANOC letter in detail

• Check your provider network and drug formulary

• Confirm your plan’s structure with respect to Medicare Advantage and Part B

• Understand the true cost of your plan—not just the premium

If you’re unsure how to compare plans or interpret the changes, professional help can make a difference.

Make Your 2025 Health Plan Work for You

Re-enrolling in a Medicare Advantage plan tied to your PSHB coverage isn’t something you can afford to do on autopilot. Benefits, provider access, prescription coverage, and even eligibility rules can change without warning. This year, make it a priority to evaluate your options fully and confidently.

Reach out to a licensed agent listed on this website for personalized help in understanding your 2025 PSHB and Medicare Advantage choices.