Key Takeaways

• PSHB coverage in 2026 includes broad medical, hospital, prescription drug, mental health, and preventive benefits, but each category has built‑in limits that affect how, when, and how much you pay over the year.

• Understanding deductibles, coinsurance, annual caps, formularies, and coordination with Medicare helps you reduce surprises and plan health expenses with greater confidence.

Understanding What PSHB Coverage Is Designed To Do

Postal Service Health Benefits (PSHB) plans are structured to provide comprehensive health coverage while sharing costs between you and the plan in a predictable way. In 2026, PSHB continues to operate as employer‑sponsored coverage with standardized benefit categories, calendar‑year resets, and clearly defined cost‑sharing rules.

Your coverage is designed to address everyday medical needs, unexpected illnesses, ongoing chronic conditions, hospital events, and prescription drug costs. At the same time, PSHB plans include limits that determine how much the plan pays at different stages of the year and how much responsibility remains with you.

These limits are not coverage gaps. Instead, they act as financial boundaries that help control total spending while still ensuring access to medically necessary care throughout the year.

What Core Medical Services Are Included

PSHB medical benefits in 2026 are organized into familiar and predictable service groups. These services form the foundation of your health coverage and typically include:

• Primary care visits for routine and ongoing care

• Specialist visits for focused or advanced treatment

• Outpatient services such as lab work, diagnostic tests, and imaging

• Inpatient hospital care for serious illness or surgery

• Emergency room and urgent care services

• Mental health and substance use disorder treatment

Most plans rely on a combination of fixed copayments and percentage‑based coinsurance. Preventive services are generally covered at no additional cost when plan guidelines are followed, while other services involve cost sharing once your deductible applies.

Where Deductibles Shape Your Early‑Year Costs

A deductible is the amount you must pay out of pocket before the plan begins paying for certain covered services. In 2026, PSHB deductibles reset on January 1, regardless of when you enrolled.

You may see:

• An individual deductible for your own care

• A family deductible that combines costs across covered family members

• Separate deductibles for in‑network and out‑of‑network services

Until the deductible is met, you usually pay the full allowed cost for many non‑preventive services. Once the deductible is satisfied, the plan begins sharing costs according to the coinsurance or copayment rules outlined in your plan.

How Coinsurance Changes What You Pay Over Time

Coinsurance is the percentage of covered costs you pay after meeting your deductible. Instead of a fixed dollar amount, your share is tied to the total allowed charge for a service.

This structure means:

• Your out‑of‑pocket costs rise and fall with the amount of care you receive

• Higher‑cost services result in higher dollar contributions from you

• Lower‑cost routine care generally results in smaller payments

Coinsurance continues to apply throughout the year until you reach your plan’s annual out‑of‑pocket maximum, at which point covered in‑network services are paid in full by the plan.

What Hospital Coverage Includes And Where Limits Apply

Hospital coverage under PSHB in 2026 is comprehensive but structured with specific cost‑sharing rules. Covered services generally include:

• Inpatient room and board

• Surgical and anesthesia services

• Diagnostic testing and imaging during admission

• Medications administered as part of inpatient care

• Related hospital‑based professional services

Limits may appear through:

• Per‑admission or daily cost sharing

• Coinsurance percentages after the deductible

• Separate rules for extended or specialized hospital stays

These limits define how costs are divided between you and the plan rather than restricting access to necessary hospital care.

How Prescription Drug Coverage Works In 2026

Prescription drug coverage remains a central part of PSHB benefits in 2026. Plans are structured to manage medication costs while maintaining access to a wide range of covered drugs.

Common features include:

• Tiered formularies that group medications by cost and category

• Copayments or coinsurance based on the drug’s tier

• Annual out‑of‑pocket tracking for covered medications

For coverage coordinated with Medicare Part D, the annual prescription drug out‑of‑pocket cap in 2026 is $2,100. After you reach this limit, covered prescription drugs cost $0 for the remainder of the calendar year.

Where Formularies And Authorization Rules Matter

Although drug coverage is broad, limits often appear through plan management tools such as:

• Formularies that assign drugs to cost tiers

• Prior authorization requirements for certain medications

• Quantity limits designed to promote safe and effective use

These rules help control costs while supporting appropriate treatment. Reviewing your plan’s formulary during Open Season allows you to anticipate potential changes for the coming year.

What Preventive Care Covers Without Extra Cost

Preventive care is one of the most valuable aspects of PSHB coverage. In 2026, preventive benefits typically include:

• Routine wellness and preventive visits

• Recommended screenings and immunizations

• Preventive tests based on age, gender, and risk factors

When services meet preventive guidelines, they are usually covered without deductibles or coinsurance. Limits may apply if frequency guidelines are exceeded or if services fall outside preventive definitions.

How Mental Health Benefits Are Structured

Mental health and substance use disorder services are included as essential benefits under PSHB. Coverage is generally aligned with medical benefits, meaning:

• Outpatient therapy and counseling visits are covered

• Inpatient and intensive outpatient treatment is included

• Cost sharing follows standard deductible and coinsurance rules

Limits most often involve authorization requirements or network considerations rather than exclusions from coverage.

Where Annual Out‑Of‑Pocket Maximums Protect You

The annual out‑of‑pocket maximum is a critical protection built into PSHB plans. In 2026, once you reach this limit:

• The plan pays 100% of covered in‑network costs for the rest of the year

• Deductibles, copayments, and coinsurance stop accumulating

This maximum resets each January 1. Monthly premiums do not count toward this limit, but most other covered cost‑sharing amounts do.

How Coverage Coordinates With Medicare

For eligible enrollees, PSHB coordinates with Medicare Parts A and B. Under this arrangement:

• Medicare generally pays first for covered services

• PSHB acts as secondary coverage

• Your remaining cost sharing may be reduced

Understanding this coordination explains why many services result in lower out‑of‑pocket costs after Medicare enrollment, even though PSHB limits and structures still apply.

What Timing Rules Affect Your Coverage Each Year

Several important timing rules shape how PSHB benefits apply in 2026:

• Deductibles and out‑of‑pocket limits reset on January 1

• Annual Open Season allows plan changes with January 1 effective dates

• Prescription drug cost phases apply across the calendar year

Awareness of these timelines helps you anticipate when costs restart and how expenses may accumulate over the year.

How Limits Support Long‑Term Plan Stability

While limits may feel restrictive at times, they play an important role in keeping PSHB plans sustainable. By sharing costs and setting annual caps:

• Premium increases are moderated over time

• Coverage remains available to a broad group of enrollees

• High‑cost medical events are financially contained

These structures help balance affordability with consistent access to care.

Putting Benefits And Limits Into Perspective

PSHB benefits in 2026 are broad, structured, and predictable. You receive coverage for most medical needs, but your total costs depend on how much care you use, when you use it, and how your plan’s limits apply.

Understanding these benefit categories and financial boundaries allows you to evaluate coverage value beyond monthly premiums alone. If you would like help reviewing how PSHB benefits and limits apply to your situation, consider reaching out to one of the licensed agents listed on this website. They can help you understand coverage rules, timelines, and coordination considerations so you can make informed decisions for the year ahead.