Key Takeaways
-
Enrolling in Medicare Part B before age 65 is essential for certain PSHB annuitants to avoid losing benefits or paying higher costs.
-
Timing matters: You must understand enrollment windows, exceptions, and how Medicare Part B coordinates with PSHB coverage starting at age 65.
Understanding the Shift That Begins at Age 65
As you approach your 65th birthday, your health benefits under the Postal Service Health Benefits (PSHB) Program begin to shift. At this age, Medicare becomes a central part of your healthcare equation. If you are a PSHB enrollee, especially an annuitant, there are critical decisions to make about Medicare Part A and Part B.
Failing to coordinate Medicare enrollment properly can result in higher out-of-pocket costs, denied claims, or even loss of PSHB drug coverage. Planning ahead can help you maintain seamless coverage, avoid penalties, and take full advantage of your benefits.
Who Must Enroll in Medicare Part B?
In 2025, certain PSHB annuitants and their covered family members are required to enroll in Medicare Part B when they become eligible. This mandate applies unless you fall into an exception category, such as:
-
You retired on or before January 1, 2025.
-
You are actively employed by USPS.
-
You are age 64 or older as of January 1, 2025.
-
You reside outside the United States.
-
You receive healthcare through the VA or Indian Health Services.
If you are not exempt, and you are eligible for Medicare Part B, failing to enroll may make you ineligible to continue prescription drug coverage under the PSHB plan. This creates a costly gap in coverage.
Key Enrollment Periods You Cannot Afford to Miss
Timing is critical. Your first opportunity to enroll in Medicare begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month. This 7-month window is your Initial Enrollment Period (IEP).
If you miss this period and do not qualify for a Special Enrollment Period (SEP), you may be forced to wait until the General Enrollment Period, which runs from January 1 to March 31, with coverage beginning July 1 of that year. Missing deadlines can result in:
-
Late enrollment penalties for Medicare Part B, which grow the longer you wait.
-
Loss of your PSHB drug benefits if you’re required to enroll but fail to do so.
How PSHB and Medicare Part B Work Together
Once enrolled in both PSHB and Medicare Part B, your benefits coordinate in a way that may reduce your healthcare expenses. In most situations:
-
Medicare becomes the primary payer.
-
Your PSHB plan acts as secondary coverage, paying most or all of the remaining balance after Medicare pays its share.
This dual coverage may result in:
-
Lower out-of-pocket costs.
-
Waived or reduced deductibles.
-
Enhanced coverage for services like durable medical equipment or skilled nursing.
In many cases, you’ll find that PSHB plans offer additional incentives, like reduced cost-sharing or even reimbursements for some of your Medicare Part B premiums.
The Importance of the Medicare Part D Integration
For 2025, if you are Medicare-eligible and enrolled in a PSHB plan, you will automatically be enrolled in a Medicare Part D Employer Group Waiver Plan (EGWP). This is a prescription drug plan offered through your PSHB carrier and coordinated with Medicare.
Key features of this integration include:
-
A $2,000 annual cap on out-of-pocket drug spending.
-
A $35 monthly insulin cost cap.
-
Access to a broad pharmacy network.
If you decline Medicare Part B and are required to enroll, your prescription drug benefits through PSHB may be terminated. Additionally, opting out of the EGWP drug plan without a qualifying reason could mean losing drug coverage altogether.
What to Expect From Your PSHB Plan After Age 65
Once you enroll in both Medicare Part A and Part B:
-
Your PSHB plan benefits may change, but you keep the same core coverage.
-
You should expect coordination of benefits between Medicare and PSHB.
-
You may no longer pay deductibles for many services.
-
You retain access to PSHB networks and providers, just as before.
However, your PSHB plan will adjust its cost-sharing structure assuming that Medicare is paying primary. If you haven’t enrolled in Medicare Part B (and you’re required to), your PSHB plan may treat you as if you have, meaning you pay significantly more out of pocket.
How to Prepare Before You Turn 65
Six to twelve months before turning 65, you should begin preparing for the coordination process:
-
Verify your eligibility for Medicare and whether you fall under the mandatory enrollment category.
-
Contact the Social Security Administration to apply for Medicare Parts A and B.
-
Review your PSHB plan materials, including coordination of benefits documents.
-
Check for any Medicare premium incentives or reimbursement programs offered by your PSHB plan.
It’s also recommended that you speak with a licensed agent who understands PSHB to make sure you enroll in the right combination of benefits.
What Happens If You’re Already on Medicare Before PSHB?
If you were already enrolled in Medicare before transitioning to the PSHB system in 2025, your Medicare coverage will continue. However, it is still critical to:
-
Confirm that your PSHB plan has integrated your Medicare details correctly.
-
Ensure you are enrolled in the PSHB version of the Medicare Part D drug plan (EGWP).
-
Review how your current healthcare providers bill under the new coordination setup.
Failure to update this information could result in claim delays or higher costs.
Medicare Part A Is Usually Automatic—But Confirm Anyway
Medicare Part A (hospital insurance) is typically premium-free if you worked and paid Medicare taxes for at least 10 years. Most people are automatically enrolled in Part A when they turn 65. However, do not assume. Always:
-
Confirm your Part A enrollment status.
-
Ensure your effective date is accurate.
If you are not automatically enrolled, apply at least three months before your 65th birthday to avoid a coverage gap.
What If You Are Still Working at 65?
If you’re an active USPS employee, you are not required to enroll in Medicare Part B at age 65. However, it is still optional, and you may choose to enroll for added coverage.
While you’re working:
-
Your PSHB plan remains your primary insurance.
-
Medicare becomes secondary if you voluntarily enroll.
Once you retire, the roles reverse. Be sure to apply for Part B during your Special Enrollment Period (SEP), which lasts for 8 months after your employment ends, to avoid a late penalty.
Coordination Tip: Always Keep Your Records Current
You should always notify both:
-
The Social Security Administration (SSA) about changes to your work or retirement status.
-
Your PSHB plan about your Medicare enrollment status.
Accurate records help ensure that coordination of benefits is smooth and your claims are processed without error.
Cost Implications: What You Could Pay Without Proper Coordination
Failing to enroll in Medicare Part B when required can lead to major financial consequences:
-
You may pay 20% or more out-of-pocket for services Medicare would have covered.
-
You could face a 10% late enrollment penalty for each 12-month period you delayed enrolling in Part B.
-
You might lose access to prescription drug coverage under PSHB entirely.
These costs can quickly surpass the annual premium for Medicare Part B. That’s why proactive enrollment is not only a smart move, but often a necessary one.
Who to Contact for Support
If you’re approaching Medicare eligibility and are currently enrolled in a PSHB plan, reach out to:
-
Social Security Administration (SSA) for Medicare eligibility and enrollment questions.
-
Your PSHB plan provider for coverage details and plan-specific integration rules.
-
A licensed agent listed on this website for a personalized review of your PSHB and Medicare options.
Planning Ahead Helps You Keep Full Coverage
You only turn 65 once, but the decisions you make this year can impact your health coverage for the rest of your retirement. As a PSHB enrollee, understanding how Medicare works with your benefits helps you avoid unnecessary costs, stay eligible for prescription coverage, and keep your health plan working the way it should.
Take action early. Review your eligibility. Apply for Medicare on time. And if you need help, get in touch with a licensed agent listed on this website who can guide you through the coordination process step-by-step.
