Key Takeaways:

• The Postal Service Health Benefits (PSHB) program provides coverage options tailored to postal employees, retirees, and their families, offering a mix of cost-sharing structures, provider networks, and benefits.

• Understanding your PSHB plan’s deductibles, co-pays, out-of-pocket limits, and integration with Medicare can help you maximize coverage and manage healthcare expenses effectively.

What the PSHB Program Means for You in 2025

The Postal Service Health Benefits (PSHB) program is now the official healthcare system for Postal Service employees, annuitants, and their eligible family members. With this transition from the Federal Employees Health Benefits (FEHB) program, it’s crucial to explore what PSHB offers and how it fits your healthcare needs.

The plans available under PSHB vary, offering different levels of coverage, provider networks, and cost structures. Whether you’re an active postal worker, preparing for retirement, or already retired, understanding your benefits ensures you make the most of your coverage.

1. Cost Sharing: What You Pay vs. What’s Covered

Healthcare expenses under PSHB plans involve different cost-sharing elements, including:

• Premiums: Monthly payments required to maintain coverage. While the federal government covers a significant portion, you are responsible for the remaining share.

• Deductibles: The amount you must pay before your plan starts covering most services.

• Co-pays and Coinsurance: A fixed amount (co-pay) or a percentage (coinsurance) you pay for doctor visits, prescriptions, and hospital services.

• Out-of-Pocket Maximums: The maximum amount you will pay annually before your plan covers 100% of covered expenses.

These cost factors vary depending on whether you choose a low-deductible plan with higher monthly premiums or a high-deductible plan with lower upfront costs but more significant out-of-pocket expenses when using services.

2. Medicare Integration: How PSHB Works with Part B

If you’re eligible for Medicare, particularly Part B (Medical Insurance), you might be required to enroll in it to maintain your PSHB coverage. The integration of Medicare with PSHB can significantly reduce out-of-pocket costs. Some benefits of pairing Medicare with your PSHB plan include:

• Lower deductibles and co-pays for covered services.

• Prescription drug savings through Medicare Part D Employer Group Waiver Plans (EGWP).

• Reduced out-of-pocket maximums, ensuring better financial protection.

Postal retirees who were already retired before January 1, 2025, may have more flexibility regarding Medicare enrollment. Understanding these requirements can help you make informed choices about your healthcare expenses.

3. Provider Networks: Choosing Your Healthcare Professionals

PSHB plans feature different provider networks, affecting the availability of in-network doctors, specialists, and hospitals. Depending on your plan, you may have:

• HMO (Health Maintenance Organization) Plans: Require you to use a set network of doctors and hospitals. You usually need a referral to see a specialist.

• PPO (Preferred Provider Organization) Plans: Offer more flexibility in choosing healthcare providers, with lower costs for in-network services and higher costs for out-of-network care.

• Fee-for-Service (FFS) Plans: Provide nationwide coverage and allow you to see any doctor, though out-of-pocket costs can be higher.

Reviewing your plan’s network can help you determine whether your preferred doctors and hospitals are included. If you travel often or live in a rural area, a broader network plan might be more beneficial.

4. Prescription Drug Coverage: What to Expect

PSHB plans include prescription drug benefits, often structured similarly to Medicare Part D coverage. Key aspects to understand include:

• Formularies: A list of covered medications categorized by tiers. Lower-tier drugs cost less, while higher-tier or specialty drugs have higher out-of-pocket costs.

• Preferred vs. Non-Preferred Pharmacies: Some plans offer lower co-pays at specific pharmacy chains.

• Mail-Order Options: Many plans provide discounts on maintenance medications through mail-order services.

If you’re enrolled in Medicare, your PSHB plan will likely use an Employer Group Waiver Plan (EGWP), which can provide additional cost savings. Make sure to review your plan’s drug coverage annually, as formularies and pricing may change.

5. Extra Benefits: What Else Does Your Plan Offer?

Beyond basic medical and prescription coverage, PSHB plans often include supplemental benefits to support your overall health. These may include:

• Telehealth Services: Virtual doctor visits for primary care, mental health support, and minor illnesses.

• Wellness Programs: Incentives for preventive screenings, weight management, and smoking cessation.

• Vision and Dental Benefits: Some plans offer coverage for eye exams, glasses, and dental cleanings.

• Hearing Aid Coverage: Discounts or allowances for hearing aids and related services.

Since these benefits vary by plan, it’s essential to compare options to find the one that best suits your needs.

Making the Most of Your PSHB Plan in 2025

Now that you understand the core aspects of PSHB, here are some tips to maximize your benefits:

• Review Your Plan Annually: Costs, coverage, and provider networks may change. Check your plan each year to ensure it still meets your needs.

• Consider Medicare Enrollment: If you’re eligible, enrolling in Medicare can reduce overall healthcare costs.

• Use Preventive Services: Many screenings, vaccines, and wellness programs are available at no additional cost. Take advantage of them.

• Keep Track of Out-of-Pocket Costs: Knowing your deductible, co-pays, and out-of-pocket maximum can help you budget for healthcare expenses.

• Check Prescription Coverage: If you take regular medications, confirm that they are covered and whether you can save money through mail-order options or preferred pharmacies.

Staying informed about your plan’s features ensures you get the most value from your PSHB coverage. If you have questions or need help selecting the right plan, speak with a licensed agent listed on this website. They can provide guidance based on your individual healthcare needs.