Key Takeaways

• Turning 65 is a critical milestone for PSHB enrollees because Medicare enrollment becomes time-sensitive and mandatory for many retirees.

• Missing your Medicare Part B window could lead to penalties, coverage gaps, or even the loss of PSHB drug benefits if you’re eligible but not enrolled.

Hitting 65 Means More Than Just a Birthday

If you’re approaching your 65th birthday, your health benefits are about to change in ways that require precise attention. The Postal Service Health Benefits (PSHB) Program is now in full effect, replacing FEHB for postal retirees as of January 1, 2025. That shift brings new coordination rules with Medicare—and it’s not optional for everyone.

At 65, you become eligible for Medicare. But under PSHB rules, you might also be required to enroll in Medicare Part B if you want to keep full PSHB coverage. Delaying that step could have permanent consequences.

Your Enrollment Window Is Ticking

You have a seven-month window to sign up for Medicare Part B. This period is called the Initial Enrollment Period (IEP). It starts three months before the month you turn 65, includes your birth month, and ends three months after that month.

For example, if your 65th birthday is in September 2025:

• Your enrollment window starts June 1, 2025.

• It ends December 31, 2025.

Waiting past this window means you could face lifetime late enrollment penalties and delayed coverage. If you’re a Postal Service retiree or a family member who is eligible for Medicare and subject to the PSHB Part B requirement, this window is crucial.

What Happens If You Miss It?

If you fail to enroll in Medicare Part B during your IEP, and you’re not exempt from the PSHB Medicare requirement, the consequences are steep:

• Loss of prescription drug coverage through your PSHB plan.

• Late enrollment penalties that grow the longer you delay Part B.

• Waiting periods for coverage if you have to enroll later during a General Enrollment Period (January 1 to March 31).

• No fallback coverage from PSHB to make up the difference.

Missing this window is not a minor misstep. It can drastically change your healthcare costs and access.

Who Must Enroll in Medicare Part B?

Not everyone has to sign up for Part B under PSHB. You are required to enroll if you meet the following conditions:

• You are a Postal Service annuitant (retiree or eligible family member).

• You become eligible for Medicare on or after January 1, 2025.

There are a few exceptions:

• If you retired on or before January 1, 2025, you are not required to enroll (though you still may want to).

• If you are living outside the U.S., you may qualify for an exemption.

• If you have VA or Indian Health Service benefits, you may be exempt as well.

But if none of these exceptions apply, enrollment in Part B is tied directly to keeping your PSHB plan fully intact.

Why PSHB Can’t Cover You Alone After 65

One of the biggest misconceptions is that PSHB is enough on its own after you turn 65. It’s not. Starting in 2025, PSHB coverage becomes deeply tied to Medicare enrollment. This means:

• Your PSHB plan coordinates with Medicare, assuming Medicare pays first.

• If you don’t have Medicare Part B, your PSHB plan might not pay for major outpatient services.

• Plans may deny claims or cover them at a much lower rate if Medicare should have been the primary payer.

Even though you’re paying PSHB premiums, that doesn’t guarantee full coverage after 65. Medicare Part B fills a vital role.

How PSHB and Medicare Work Together

Once you enroll in Medicare Part A and Part B, your PSHB plan typically becomes your secondary insurer. Here’s what that coordination looks like:

• Medicare pays first for covered services.

• PSHB pays second, often covering deductibles, coinsurance, and other costs Medicare doesn’t fully pay.

• For prescription drugs, PSHB includes an integrated Medicare Part D plan for eligible members.

When both are working together, your out-of-pocket costs can drop significantly. But when only PSHB is in play—without Medicare Part B—your protection is limited.

Special Enrollment Periods: Not a Guaranteed Safety Net

Some retirees assume they can wait and use a Special Enrollment Period (SEP) later to sign up for Medicare Part B without penalties. That’s only true in limited cases:

• If you delayed Part B because you were still actively working and covered under an active employer health plan.

• If you move out of the U.S. and return later.

But if you’re already retired when you turn 65, you do not qualify for this SEP. Your only penalty-free option is your Initial Enrollment Period.

What About Spouses and Family Members?

The PSHB Medicare Part B requirement applies not only to you but also to your covered family members if they’re eligible for Medicare. That means your spouse or adult dependent turning 65 also needs to:

• Enroll in Medicare Part B during their IEP.

• Continue that enrollment for as long as they are covered under your PSHB plan.

If they don’t enroll, they too risk losing prescription drug coverage and cost-sharing benefits. Everyone on your plan who qualifies for Medicare must follow the rules.

Premiums You Need to Plan For

While we can’t quote private plan prices, it’s important to understand that enrolling in both PSHB and Medicare Part B means paying two separate premiums:

• One to your PSHB plan (your monthly premium).

• One to Medicare for Part B (which in 2025 is $185/month for most people).

For some, the cost seems like double-dipping. But in reality, this combination often reduces your total out-of-pocket costs—if timed and enrolled correctly.

What the Part B Requirement Protects You From

The Medicare Part B requirement under PSHB isn’t just a bureaucratic hurdle. It’s designed to:

• Shield you from high out-of-pocket costs for outpatient care.

• Make sure you get drug coverage through the integrated Part D plan.

• Prevent billing issues between Medicare and PSHB carriers.

• Allow better coordination of care and claim processing.

Skipping it exposes you to coverage gaps you may not be able to fix later.

Don’t Count on Open Season to Fix This

Once you miss your Initial Enrollment Period for Medicare Part B, Open Season won’t help. PSHB Open Season (typically November to December) is only for changing plans within the PSHB program. It does not offer a workaround for Medicare enrollment.

So even if you choose the best PSHB plan available, it won’t cover services Medicare Part B should’ve paid for if you’re not enrolled. You can’t delay this decision and hope to catch up during the next Open Season.

How to Get Ahead—Starting Now

If your 65th birthday is within the next year, you should:

• Mark your calendar three months before your 65th birthday.

• Visit Medicare.gov to start your application.

• Review your PSHB plan brochure to understand coordination of benefits.

• Check whether your family members are also affected.

Avoid procrastination. PSHB will assume Medicare is paying first once you hit 65. If you haven’t signed up, it’s your wallet on the hook.

Planning for 2025 and Beyond

Because PSHB is still new in 2025, some postal retirees are still adjusting to the transition. That’s why this year, more than any other, requires careful planning. The biggest takeaway?

Turning 65 is not the time to guess. Medicare enrollment isn’t automatic, and your PSHB plan won’t wait while you get organized.

The cost of waiting is too high. The opportunity window is too short. And the consequences are permanent.

Know the Stakes, Take the Next Step

Missing Medicare Part B enrollment at age 65 can upend your entire PSHB experience. It’s not just about compliance—it’s about protecting your health and your finances.

If you’re uncertain about your timeline or coverage requirements, it’s wise to speak with a licensed agent listed on this website. They can walk you through the timelines, check your eligibility, and help you avoid costly mistakes.