Key Takeaways

• Copayments under Postal Service Health Benefits (PSHB) may seem minor at first, but they can compound significantly over time, especially if you have frequent doctor visits or prescriptions.

• Reviewing your plan’s copayment structure annually and understanding how services are categorized can help you make smarter health choices and reduce out-of-pocket spending.

The Basics of Copayments Under PSHB

Copayments are one of the most familiar aspects of health insurance. They’re fixed-dollar amounts you pay out-of-pocket for specific healthcare services—like $30 for a specialist visit or $15 for a primary care appointment. Under the 2025 Postal Service Health Benefits (PSHB) program, copayments vary by plan and by the type of care received. While they may seem manageable individually, they can become a significant expense over time.

PSHB plans often use copayments for:

• Primary and specialist office visits

• Urgent care and emergency room services

• Prescription medications (with tiers for generic, preferred brand, and non-preferred drugs)

• Mental health and substance use services

Even though they are predictable, their frequency matters—and it’s easy to underestimate how much they accumulate over the course of a year.

Why Copayments Can Quietly Strain Your Budget

In 2025, most PSHB enrollees face typical copayments ranging from $20 to $60 for in-network services. If you only visit the doctor occasionally, these fees may not seem like much. But when you begin tracking every appointment, every prescription refill, and every urgent care visit, it adds up.

Here’s what increases your exposure:

• Chronic conditions: Regular specialist visits, labs, and medications multiply your copayment totals.

• Family coverage: When multiple people are using the plan, the cost impact grows exponentially.

• Behavioral health services: Weekly or biweekly therapy sessions each carry a separate copay.

• Urgent care usage: Even one visit per quarter means four copays in a year—before considering any tests or follow-ups.

A sense of affordability is often misleading. Many PSHB participants overlook how even a $30 copayment, multiplied dozens of times, can exceed $500 to $800 annually depending on usage.

How PSHB Defines and Applies Copayments

Under PSHB plans, copayments are typically tied to in-network providers. That means as long as you’re using a provider within the plan’s preferred network, you pay the listed copay, and the plan covers the rest of the allowed amount.

Out-of-network visits, on the other hand, often do not use a fixed copayment. Instead, you might pay coinsurance or face balance billing. So knowing whether a provider is in-network is essential to understanding what your copay will be.

Different categories also affect your cost:

• Tiered prescription drugs: Copayments vary between tiers, encouraging use of generics.

• Preventive services: Typically covered in full with no copay, but only if billed properly.

• Emergency services: Usually the highest copay levels across PSHB plans.

Each PSHB plan has its own Summary of Benefits and Coverage that lists copayment amounts. You should review this each year, as changes from 2024 to 2025 have adjusted many copay levels.

Copayments vs. Coinsurance: Know the Difference

While both represent out-of-pocket costs, copayments and coinsurance are not the same.

• Copayment: A fixed dollar amount (e.g., $40 per visit).

• Coinsurance: A percentage of the cost (e.g., 20% of a $200 bill).

In PSHB plans, copayments are more common for predictable, routine care. Coinsurance usually applies to higher-cost services like hospitalizations or outpatient surgeries. However, some services can include both. For example, you might have a copayment for an office visit and coinsurance for a diagnostic test during the visit.

The Importance of Tracking Your Healthcare Usage

To prevent surprises, consider keeping a record of your healthcare usage throughout the year. Even a basic spreadsheet can help you identify patterns and forecast your expenses under PSHB.

Track items like:

• Number of office visits per month

• Therapy or mental health appointments

• Prescription refills by tier

• Urgent care or ER visits

This type of personal data is useful during Open Season (each November through December) when you’re selecting or adjusting your PSHB plan. Comparing total expected copayments against each plan’s structure can help you find the most cost-effective fit.

Ways to Manage and Reduce Copayment Costs

Although you can’t eliminate copayments, you do have control over how often they show up. Here are some practical strategies:

1. Use Preventive Services

Annual checkups, vaccinations, and screenings are often free under PSHB when in-network. These can help catch health issues early and reduce the need for repeated visits.

2. Consider Telehealth Options

Many PSHB plans in 2025 offer reduced or waived copayments for telehealth. For non-urgent issues, virtual visits can save both time and money.

3. Request 90-Day Prescriptions

Instead of monthly pharmacy trips, request a 90-day supply. You may pay one copayment per 90 days instead of three.

4. Stick to In-Network Providers

Always verify that your provider is in-network. Out-of-network visits may not use copayments at all and can result in higher out-of-pocket charges.

5. Review Mental Health Options

Mental health services can be frequent, making copays add up. Look for plans with lower copays for therapy sessions, or those that offer telehealth therapy at reduced costs.

6. Use Mail-Order Pharmacies

Many PSHB plans incentivize mail-order pharmacy use, which can reduce copayments for maintenance drugs.

Annual Out-of-Pocket Maximums and Their Role

Each PSHB plan includes an out-of-pocket maximum, which puts a cap on how much you’ll spend in a year. Copayments count toward this cap. In 2025, the in-network out-of-pocket limits range from $7,500 for Self Only to $15,000 for family plans.

Once you hit your plan’s maximum, the PSHB plan covers 100% of further covered in-network costs for the remainder of the year. However, reaching this point usually means significant healthcare usage, so it’s not something to rely on for routine planning.

Reassessing Your Copayment Exposure Each Year

Don’t treat your health plan like a set-it-and-forget-it decision. Each Open Season, examine how your copayment totals compared to your healthcare usage.

Ask yourself:

• Did I have more copayments than expected?

• Were certain services unusually frequent?

• Could I reduce copays by changing providers, prescriptions, or care methods?

If your copayments in 2024 exceeded your expectations, consider choosing a different PSHB plan in 2025 with:

• Lower copays for the services you use most often

• Better coverage for your prescriptions

• Telehealth benefits to offset in-person visit costs

Your plan selection can make a noticeable difference over 12 months.

What to Watch for in 2025 PSHB Copayment Updates

The shift to PSHB from FEHB means some cost-sharing structures have changed. Compared to 2024, 2025 copayment ranges have adjusted to reflect:

• More tiered prescription categories

• Emphasis on virtual care options

• Expanded behavioral health access with variable cost-sharing

• Adjustments to urgent and emergency visit fees

These changes mean that plans you were comfortable with under FEHB in 2024 may no longer be the most affordable under PSHB in 2025. Comparing updated benefit brochures is essential.

Being Proactive Can Protect Your Finances

Copayments are deceptively simple. They’re easy to overlook in isolation, but their cumulative effect matters. Being intentional about how often you access care—and under what circumstances—can help you reduce your exposure.

If you’re unsure whether you’re in the right PSHB plan or if your copayment burden feels too high, now is the time to speak with someone who can help.

Small Fees, Big Impact—Be Smart About Copayments

Managing your copayments under PSHB requires more than just hoping for low usage. It means being aware of how services are categorized, tracking your healthcare habits, and adjusting your plan accordingly.

The good news? You have resources. During Open Season, and even throughout the year if you face a qualifying life event, you can take steps to optimize your coverage.

Speak with a licensed agent listed on this website to review your current plan and future options. Don’t wait until the bills start stacking up—be proactive now.