Key Takeaways

• Your deductible is often the first large out-of-pocket cost under PSHB, and many enrollees underestimate it.

• Understanding how in-network vs. out-of-network services impact your deductible is key to avoiding unexpected bills.

The One Line on Your PSHB Plan That Can Cost You First

When you first sign up for a Postal Service Health Benefits (PSHB) plan, the immediate focus tends to be on premiums. But the first significant cost you might actually feel isn’t your monthly premium—it’s your deductible. This is especially true early in the plan year or after your first major medical visit.

A deductible is the amount you pay out-of-pocket for covered health care services before your plan starts to pay. And in 2025, this figure can feel substantial, especially if you aren’t prepared for it.

What Deductibles Look Like in PSHB Plans

Deductibles under PSHB vary depending on your plan type and whether the care you receive is in-network or out-of-network. Here’s a general overview:

• In-network deductibles tend to range from $350 to $500 for Self Only coverage.

• High-deductible plans may require $1,500 or more upfront.

• Self Plus One or Self and Family coverage sees higher deductibles, often double the Self Only amount.

• Out-of-network deductibles can be much steeper, reaching into the $1,000 to $3,000 range.

These figures reset annually, usually on January 1, meaning your out-of-pocket tally starts fresh each year.

When You Pay the Deductible

You will typically encounter the deductible when:

• Getting lab work, imaging, or other diagnostic services.

• Visiting specialists outside of preventive care.

• Receiving hospital care that is not emergency-based.

• Undergoing outpatient surgery or receiving durable medical equipment.

Until your deductible is met, you cover the full allowed cost for these services, not just a copayment.

Preventive Care Isn’t the Problem

It’s important to note that preventive care is usually covered 100% by your PSHB plan when using in-network providers. That includes annual checkups, screenings, vaccines, and certain wellness visits.

The confusion often comes when a visit that seems preventive turns diagnostic. For example, a routine screening might lead to additional tests or referrals—and suddenly, you’re paying toward the deductible.

How Your Deductible Interacts with Other Costs

Once you meet your deductible, your plan begins to share the cost through either copayments or coinsurance. But meeting the deductible doesn’t mean you’re in the clear.

• Coinsurance: After your deductible, you might still owe 10% to 30% of the allowed cost.

• Out-of-pocket maximum: If you continue needing care, all your costs (including deductible, coinsurance, and copays) contribute to this limit. Once it’s met, the plan pays 100% of covered in-network costs.

So, think of the deductible as your entry fee into the broader cost-sharing structure.

The medicare Factor for Annuitants

If you’re a Postal Service annuitant and enrolled in Medicare Part B, your experience with deductibles may differ. Many PSHB plans coordinate with Medicare to reduce or even waive deductibles entirely for covered services.

That said, this depends heavily on plan design, and you must be enrolled in both the PSHB plan and Medicare Part B for this benefit to apply. It’s a smart move to verify this with your plan’s summary of benefits.

What Happens If You Go Out of Network

This is where your costs can spiral quickly. Out-of-network deductibles are higher, and there is no cap on what providers can charge above the plan’s allowable amount. This is called balance billing.

Let’s say your plan allows $500 for a procedure, but an out-of-network provider charges $900. You might be responsible for the $500 deductible plus the $400 difference. Always check network status beforehand.

Annual Rollover of Deductibles: Not a Thing

Unlike some dental or vision benefits, your medical deductible does not carry over from one year to the next. If you met your deductible in 2024, it has no impact in 2025. This means:

• Every January 1, your deductible resets.

• Any expenses paid toward it the previous year are not credited forward.

It’s essential to plan ahead and budget each year based on the new deductible.

Planning for Your First Large Medical Bill

To avoid surprise expenses, it helps to:

• Review your plan brochure annually during the November to December Open Season.

• Call your provider to confirm network status before scheduling services.

• Use PSHB online tools to estimate your share of costs based on your coverage.

• Keep track of your deductible spending with your plan’s online portal or app.

Being proactive can prevent one bill from catching you off guard.

Common Missteps That Trigger Deductible Surprises

Several common situations lead to early or unexpected deductible payments:

• You visit a provider assuming preventive care, but the service is coded as diagnostic.

• You get imaging (like MRIs or CT scans) that isn’t part of an annual screening.

• A specialist refers you for outpatient treatment without discussing cost.

• You use urgent care or ER services that don’t qualify for copay-only pricing.

Even experienced enrollees sometimes face these scenarios. The PSHB system is new in 2025, but the mechanics of deductibles follow long-established health insurance patterns.

Coordination with HSAs and FSAs

If you’re enrolled in a high-deductible health plan (HDHP) under PSHB, you’re likely eligible for a Health Savings Account (HSA). These accounts let you save pre-tax dollars to pay for qualified medical expenses—including deductibles.

For 2025:

• Individuals can contribute up to $4,300.

• Families can contribute up to $8,550.

• There’s an extra $1,000 catch-up contribution allowed for those aged 55+.

Flexible Spending Accounts (FSAs) are also available to some Postal employees. FSAs allow you to set aside funds tax-free for medical expenses, but they have a lower contribution limit and use-it-or-lose-it rules.

Retirees and Deductibles: A Different Experience

If you’re retired, your deductible experience depends on whether you’re coordinating with Medicare. Without Medicare Part B, you could be paying full deductibles under your PSHB plan. With Medicare Part B, your plan may waive or reduce those deductibles—a significant financial relief.

Always confirm with your plan whether this coordination benefit applies to your coverage.

Final Thoughts on Managing Your First PSHB Expense

Your deductible isn’t just a number on paper—it’s a cost you’ll likely feel sooner than later. That’s why it deserves your attention right now, not just when you receive your first bill.

Start by reviewing your PSHB plan’s deductible structure, confirm whether you’ll owe this amount up front for certain services, and explore whether Medicare coordination could reduce the burden. Also, don’t overlook your eligibility for HSAs or FSAs, especially if you want to soften the financial impact.

To discuss your plan’s deductible and how to prepare for it, speak with a licensed insurance agent listed on this website who can walk you through your options clearly and confidently.