Key Takeaways

• The transition from FEHB to PSHB impacts current and retired postal employees, affecting plan options, costs, and Medicare integration.

• Understanding the differences between these programs helps you make informed choices about your healthcare coverage in 2025 and beyond.

Understanding FEHB and PSHB: What’s Changing?

If you’re a United States Postal Service (USPS) employee or retiree, you may already be familiar with the Federal Employees Health Benefits (FEHB) Program. However, starting January 1, 2025, postal employees and annuitants must enroll in the new Postal Service Health Benefits (PSHB) Program to maintain their coverage. This major shift in healthcare options raises several questions about how the two programs compare and what it means for your coverage going forward.

Who Needs to Enroll in PSHB?

The PSHB program applies to all current USPS employees, retirees, and eligible family members. However, if you’re covered under a family member’s FEHB plan who is not a postal worker, you can remain under that coverage. If you are a USPS annuitant, you must switch to a PSHB plan during the Open Season unless you qualify for specific exemptions, such as being a retiree from before January 1, 2025, who has not enrolled in Medicare Part B.

Comparing Coverage Options: FEHB vs. PSHB

Plan Availability and Choices

Under FEHB, postal employees had access to the same health plans as other federal workers. With PSHB, the plan selection is specifically designed for USPS employees and retirees. While many of the same insurers offer plans in PSHB, the coverage, benefits, and cost structures may differ.

One of the key benefits of PSHB is that it tailors coverage to the needs of postal employees, potentially offering benefits that align more closely with your work-related healthcare needs. However, it’s crucial to review available plans to ensure you select the one that best fits your medical needs and budget.

Premiums and Government Contributions

FEHB plans had a standard premium-sharing arrangement where the government covered approximately 70% of the premium costs. PSHB maintains a similar structure, with the federal government still contributing to the cost of coverage. However, exact premium amounts vary depending on the specific PSHB plan you choose, your enrollment category (Self, Self Plus One, or Self and Family), and whether you coordinate benefits with Medicare.

Deductibles and Out-of-Pocket Costs

With both FEHB and PSHB, deductibles, copayments, and coinsurance differ based on the plan selected. In general:

• Low-deductible plans offer higher monthly premiums but lower out-of-pocket costs when receiving care.

• High-deductible plans typically have lower premiums but higher out-of-pocket costs before coverage fully kicks in.

• Some PSHB plans waive deductibles for retirees enrolled in Medicare Part B, potentially lowering healthcare costs.

Medicare Coordination for Retirees

One of the most significant changes under PSHB is the requirement for Medicare-eligible retirees and their covered family members to enroll in Medicare Part B. This integration aims to lower overall healthcare expenses by allowing Medicare to handle primary coverage while PSHB provides secondary benefits, reducing copayments and out-of-pocket expenses.

This requirement applies to USPS annuitants who retire on or after January 1, 2025. However, if you retired before this date and are not enrolled in Medicare Part B, you may be exempt from this mandate.

What to Expect for Prescription Drug Coverage

Both FEHB and PSHB include prescription drug coverage, but PSHB has a crucial change for Medicare-eligible enrollees. Retirees who are enrolled in Medicare Part B will automatically receive prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP). This means:

• Lower prescription drug costs due to Medicare subsidies.

• A $2,000 out-of-pocket cap in 2025, eliminating the Medicare Part D coverage gap (previously known as the donut hole).

• Simplified cost-sharing between Medicare and PSHB plans.

For active employees or retirees not yet eligible for Medicare, PSHB continues to provide prescription drug benefits through its plan offerings, similar to FEHB.

Enrollment Periods and Deadlines

Open Season

The Open Season for enrolling in PSHB typically runs from mid-November to mid-December each year. The 2025 Open Season dates are November 11 to December 13. During this period, you can:

• Choose a new PSHB plan.

• Switch from one PSHB plan to another.

• Enroll in a PSHB plan if you were previously uninsured.

Special Enrollment Periods (SEPs)

You may qualify for a Special Enrollment Period (SEP) outside of Open Season if you experience certain life events, such as:

• Marriage, divorce, or legal separation.

• Birth or adoption of a child.

• Loss of other healthcare coverage.

How to Choose the Right PSHB Plan for You

1. Evaluate Your Healthcare Needs

Consider your medical history, expected doctor visits, prescription drug usage, and anticipated healthcare expenses. If you have chronic conditions requiring frequent care, a plan with a lower deductible and better specialist coverage may be ideal.

2. Review Premiums, Deductibles, and Out-of-Pocket Costs

Balancing monthly premium costs with potential out-of-pocket expenses can help you find a cost-effective plan. If you’re eligible for Medicare Part B, check how it integrates with your chosen PSHB plan.

3. Compare Provider Networks

Ensure your preferred doctors, specialists, and hospitals are covered within your PSHB plan’s network to avoid higher out-of-network costs.

4. Consider Extra Benefits

Some PSHB plans offer additional benefits such as:

• Vision and dental coverage.

• Wellness programs.

• Telehealth services.

• Hearing aids and mental health support.

Reviewing plan details will help you select coverage that aligns with your lifestyle and healthcare priorities.

What You Need to Do Next

If you are a USPS employee or retiree, it’s essential to stay informed about PSHB and make the necessary enrollment changes during Open Season. Check your eligibility for Medicare Part B if you’re a retiree, review available plans, and select the best option to ensure continued coverage in 2025 and beyond.

For personalized assistance, speak with a licensed agent listed on this website. They can help you navigate plan options, understand costs, and make the best decision for your healthcare needs.