Key Takeaways

• The main difference between Self Only and Self Plus One coverage under the Postal Service Health Benefits (PSHB) Program is who is covered under the plan: Self Only covers just you, while Self Plus One covers you and one eligible family member.

• Cost, coverage needs, and long-term considerations should guide your decision, especially during Open Season or when you experience a Qualifying Life Event.

Understanding PSHB Coverage Options in 2025

As a USPS employee or retiree, you are now covered under the Postal Service Health Benefits (PSHB) Program, which replaced the FEHB program beginning January 1, 2025. This shift introduces a new opportunity—and responsibility—to evaluate your health insurance coverage type.

Two of the most commonly selected options are Self Only and Self Plus One. Understanding the specifics of each will help you choose the coverage that aligns with your health needs, financial situation, and future plans.

What Does Self Only Coverage Include?

Self Only coverage under the PSHB Program means you are the only person enrolled in the plan. This option is typically chosen by:

• Single individuals with no dependents

• Married individuals whose spouse has separate coverage

• Retirees with no eligible family members

Coverage Features

• Comprehensive medical coverage for you alone

• Preventive care, primary and specialist visits, mental health services

• Access to prescription drug coverage, especially if you’re Medicare-eligible

• Lower premiums compared to plans that cover multiple individuals

• In-network and out-of-network coverage, depending on the specific plan selected

Ideal For:

• Retirees living alone or with a spouse who has other coverage

• Employees whose dependents are covered through a different employer

• Anyone looking to minimize costs while still maintaining robust healthcare coverage

What Does Self Plus One Coverage Include?

Self Plus One coverage means you are enrolling in a plan that covers yourself and one eligible family member. This may be a spouse, a child under age 26, or another qualifying relative.

Coverage Features

• Includes all the services provided under Self Only

• Extends those benefits to your one designated family member

• Offers a more affordable option than Self and Family coverage

• Shared deductible and out-of-pocket maximum, depending on the plan

Eligible Family Members Include:

• A legal spouse

• Biological and adopted children under age 26

• Stepchildren or foster children in your custody

• Disabled children over age 26 who are incapable of self-support

Comparing the Two: Self Only vs. Self Plus One

When weighing these two options, it’s essential to focus on your household’s current and anticipated health needs.

1. Cost Considerations

Self Plus One will always cost more than Self Only, but significantly less than Self and Family. The price difference is tied to the number of people covered. While exact premiums vary by plan, in 2025:

• Self Only coverage remains the most budget-friendly

• Self Plus One offers a balance between coverage and cost

2. Medicare Integration

For Medicare-eligible USPS retirees, the coordination between PSHB and Medicare Part B plays a crucial role. If both you and your covered family member are enrolled in Medicare Part B:

• Some PSHB plans offer waived deductibles or reduced copayments

• Drug coverage is included through the Medicare Part D EGWP

• Self Plus One enrollees should ensure both members are enrolled in Medicare to maximize benefits

3. Out-of-Pocket Expenses

Shared deductibles and out-of-pocket maximums are a big factor. Under Self Plus One:

• Your family member’s medical costs count toward the same limits as yours

• This can be financially helpful if both of you need frequent care

Under Self Only:

• You’re the only one contributing to and benefiting from the plan’s cost limits

4. Qualifying Life Events (QLEs)

You’re allowed to switch between Self Only and Self Plus One during Open Season or after a Qualifying Life Event. Common QLEs include:

• Marriage

• Divorce or annulment

• Birth or adoption of a child

• Death of a family member

Outside of Open Season, QLEs are your only chance to make a coverage change unless you’re a new enrollee or experiencing a loss of other coverage.

5. Long-Term Planning

Retirement planning often includes decisions about long-term healthcare costs. If you anticipate needing to care for a spouse in the coming years—or if you expect your spouse will rely on your coverage—it may make more sense to opt for Self Plus One sooner rather than later.

Choosing the Right Plan During Open Season

Each year, Open Season runs from November to December. This is your window to reassess your PSHB plan and make changes if necessary.

Questions to Ask Yourself

• Do I have an eligible family member who needs coverage?

• Is my spouse or dependent already covered elsewhere?

• Am I or my family member enrolled in Medicare Part B?

• Are there any major health changes expected next year?

• Would the higher cost of Self Plus One be offset by anticipated usage?

Answering these questions helps guide your selection.

When Self Plus One Is More Cost-Effective Than You Think

It’s common to assume Self Only is always cheaper. While that’s generally true in terms of premiums, Self Plus One could reduce total out-of-pocket costs if:

• Both you and your family member have high prescription needs

• One or both of you require frequent specialist care

• You anticipate surgical procedures, chronic care, or ongoing therapy

Depending on the PSHB plan and your Medicare status, benefits may stack in a way that reduces your total expenses more effectively under Self Plus One.

The Risk of Overpaying for Coverage

Some retirees mistakenly keep Self Plus One after the death of a spouse or when a child ages out of eligibility. In such cases, you might be paying for coverage that only benefits you—essentially turning your Self Plus One into a very expensive Self Only plan.

Regular review of your coverage during Open Season is essential to avoid this kind of overpayment.

Don’t Overlook PSHB Integration With Medicare Part D

As of 2025, PSHB plans include integrated prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP). This matters most if you or your family member is Medicare-eligible. Key benefits:

• Automatic enrollment into the Part D EGWP

• $2,000 out-of-pocket cap for prescription drugs

• $35 monthly insulin cap

This applies to both Self Only and Self Plus One coverage types, but the savings can be especially significant for couples who both take high-cost medications.

How Your Family’s Medical Profile Affects the Best Choice

If you or your eligible dependent has a chronic illness, mobility issue, or requires frequent provider visits, that should heavily influence your selection.

Under Self Plus One:

• You’re budgeting for two people’s healthcare needs

• The shared out-of-pocket max can make care more affordable for families managing ongoing conditions

Under Self Only:

• You’re covering only your own health, making this choice more efficient for healthy individuals with limited care needs

Why This Decision Isn’t One-Size-Fits-All

Your choice between Self Only and Self Plus One will depend on factors that evolve over time:

• Relationship status

• Family member eligibility

• Medicare enrollment status

• Healthcare utilization trends

• Financial goals in retirement

Reassessing your needs each year is not just smart—it’s necessary to avoid paying more than you should or getting less coverage than you need.

Choosing Wisely Now Can Save You Later

The differences between Self Only and Self Plus One coverage under PSHB in 2025 may seem straightforward, but the impact they have on your finances, peace of mind, and healthcare access is significant. Whether you’re still working or already retired, selecting the right coverage type isn’t just a box to check during Open Season—it’s a strategic decision.

If you’re unsure which option fits best with your current life stage or medical needs, it’s worth speaking with a licensed agent listed on this website for personalized guidance.