Key Takeaways

• Even with government subsidies, your PSHB premiums in 2025 could be higher than necessary if you’re in a plan that doesn’t fit your usage or Medicare status.

• A careful review of your PSHB plan’s structure, including cost-sharing, provider networks, and Medicare coordination, is essential to determine if you’re paying more than you should.

Why Premium Awareness Matters More Than Ever in 2025

The Postal Service Health Benefits (PSHB) program, fully launched in 2025, has shifted how premiums are calculated and experienced. While the plans are subsidized and offer broad federal-style coverage, many postal employees and retirees may still be overpaying — not because the premiums are incorrect, but because the selected plan doesn’t match their actual needs.

Understanding how to assess whether your premium cost is truly fair for the coverage you receive requires looking beyond the surface. You need to evaluate your usage, coordination with Medicare, provider access, and even out-of-pocket limits.

Step One: Know Your Premium Share

Although the federal government contributes roughly 70% of the PSHB premium cost, you pay the rest. The amount you’re responsible for depends on the plan you select and the enrollment type (Self Only, Self Plus One, or Self and Family).

In 2025:

• Monthly premiums for annuitants can range significantly, from low $200s to over $500.

• Employees see biweekly deductions that may look modest, but they add up quickly if the plan isn’t a fit.

It’s crucial to know what you’re actually paying monthly — and whether that rate aligns with your healthcare usage.

Step Two: Match Premiums to Your Healthcare Usage

Low premiums don’t always equal low total costs. In fact, you might pay more across the year in deductibles, coinsurance, or out-of-network services if you’re not in the right plan for your situation.

Consider:

• Do you visit doctors or specialists often?

• Are you managing a chronic condition?

• Do you rarely seek care except for preventive services?

If you’re healthy and don’t use many services, you may not need a high-premium plan with low cost-sharing. On the other hand, if you use a lot of care, a higher premium could save you more in the long run by reducing other out-of-pocket expenses.

Step Three: Assess Medicare Integration

Many PSHB plans in 2025 offer significant cost-sharing advantages if you are also enrolled in Medicare Part B. But those benefits only kick in if you actually carry Medicare.

Ask yourself:

• Are you required to enroll in Medicare Part B for PSHB eligibility?

• Is your plan waiving deductibles or copayments for Medicare enrollees?

• Are you paying for Part B, but enrolled in a plan that doesn’t reduce your cost-sharing?

If you’re paying full premiums and Medicare Part B, but not receiving any integrated benefits like reduced coinsurance or copays, you’re likely overpaying without value.

Step Four: Look at Out-of-Pocket Maximums

The PSHB program sets a maximum limit on what you pay out-of-pocket annually. For 2025, these limits are:

• $7,500 for Self Only (in-network)

• $15,000 for Self Plus One or Self and Family (in-network)

While these caps offer protection, they vary significantly by plan. Some high-deductible plans reach these thresholds faster due to higher coinsurance. You might be in a plan where you hit the limit too soon each year, meaning the lower premium wasn’t actually cheaper in the end.

Compare this:

• Lower premium + higher cost-sharing = riskier if you need frequent care.

• Higher premium + lower out-of-pocket = possibly cheaper over time.

Step Five: Examine Network Coverage

In 2025, PSHB plans differ widely in provider networks. Some are national, some are regional. If your plan limits access to local doctors or makes you go out-of-network for key services, you’re likely spending more in both direct costs and time.

Look into:

• Are your regular providers in-network?

• Do you have access to preferred hospitals or specialists?

• Have you had to pay more because your provider was unexpectedly out-of-network?

Paying a premium for a limited network adds up to a hidden cost you may not be tracking.

Step Six: Understand the Drug Coverage Structure

Most PSHB plans offer prescription drug coverage, often enhanced through a Medicare Part D Employer Group Waiver Plan (EGWP) for those enrolled in Medicare. The new $2,000 annual cap in 2025 under Part D makes this more attractive — but not all plans handle it the same.

You might be paying too much if:

• You aren’t getting the $2,000 cap because you opted out of Medicare Part D.

• Your PSHB plan doesn’t integrate drug coverage efficiently.

• Tier pricing structures place your medications at higher coinsurance levels.

Check your drug usage, see where your meds fall on the formulary, and evaluate if the premiums are giving you sufficient coverage.

Step Seven: Verify You’re Not Over-Insuring

It’s common to select a richer plan “just in case.” But in 2025, with the Part D out-of-pocket cap and robust PSHB-Medicare coordination, many retirees don’t need excessive coverage.

Questions to ask:

• Have you been using all the benefits in your plan?

• Do you have duplicate benefits from another source?

• Could you choose a lower-cost plan with similar Medicare coordination?

Over-insuring leads to high premiums for benefits you don’t actually use or need.

Step Eight: Evaluate Dependents vs. Enrollment Type

Choosing between Self Plus One and Self and Family affects premiums. In 2025, Self and Family plans typically cost more. But if your family situation has changed — like a child aging out or a spouse getting other coverage — you may still be paying family rates unnecessarily.

Make sure:

• All dependents on your plan are still eligible.

• You’re not carrying family coverage when only two of you need it.

• You reevaluate enrollment type each Open Season.

This simple review could cut your premiums by hundreds annually.

Step Nine: Revisit Plan Comparison During Open Season

Open Season (each year from November to December) is your chance to re-shop plans. Inertia is expensive. Just because you had a plan under FEHB doesn’t mean it’s the best one under PSHB.

In 2025:

• New PSHB-specific brochures are available.

• You can use online comparison tools to line up premiums, deductibles, coinsurance, and prescription coverage.

• Plan offerings have shifted, so review them annually.

Failing to compare options each year often leads to paying for outdated or mismatched coverage.

Step Ten: Watch for Cost-Sharing Cliffs

Certain services under PSHB plans have tiered or stepped cost-sharing. This can mean a service appears low-cost at first glance but escalates quickly depending on provider type, location, or tier.

Examples include:

• Tiered copayments for specialists vs. generalists

• Higher coinsurance for outpatient surgeries at non-preferred facilities

• Behavioral health services with session limits or caps

These cliffs can dramatically increase your costs beyond the premium. If your plan frequently triggers these scenarios, it might be time to switch.

What This All Adds Up To

The PSHB program in 2025 was designed to modernize and stabilize postal health benefits. But premium costs are only one part of the equation. To truly determine whether you’re overpaying, you must take a layered approach:

• Compare usage to plan structure

• Coordinate properly with Medicare

• Review provider access and prescription tiers

• Reassess family coverage needs annually

Only then can you ensure that the premium you pay is worth the benefits you receive. If anything feels off, it probably is.

Find Out What You Could Be Saving

The right PSHB plan in 2025 should support your health needs without draining your wallet. If you’re unsure whether your current plan makes sense for your usage and Medicare status, it may be time to review your options. A licensed agent listed on this website can walk you through the numbers and help ensure you’re not unknowingly paying too much.