Key Takeaways

• Your biweekly or monthly PSHB premium deduction is only part of what you’re actually paying: You’re also budgeting for deductibles, copays, coinsurance, and possibly Medicare Part B.

• Knowing your true total cost puts you in control during Open Season and helps prevent financial shocks later.

What You Think You’re Paying Isn’t the Whole Picture

When you look at your paycheck deduction for Postal Service Health Benefits (PSHB), it’s easy to think that’s your entire cost. In 2025, your real contributions go far beyond that. They include:

• Premium contributions

• Annual deductibles

• Copayments for routine and specialty care

• Coinsurance for hospital stays, surgeries, diagnostics

• Prescription drug out-of-pocket costs

• Potential Medicare Part B premiums if you’re eligible

Depending on your plan tier and healthcare needs, these combined elements can sum up to several thousand dollars annually.

Your Share of Premiums in 2025

In 2025, the federal government covers approximately 72% of the weighted average premium across all PSHB plans. Your average share is as follows:

• Self Only

  • Employee biweekly premium: ~$397.35

  • Employee monthly premium: ~$860.93

• Self Plus One

  • Employee biweekly premium: ~$858.89

  • Employee monthly premium: ~$1,860.93

• Self and Family

  • Employee biweekly premium: ~$934.65

  • Employee monthly premium: ~$2,025.08

The employer (federal government) contributes up to:

• Self Only: ~$286.09 biweekly / ~$619.86 monthly

• Self Plus One: ~$618.40 biweekly / ~$1,339.87 monthly

• Self and Family: ~$672.95 biweekly / ~$1,458.06 monthly

That federal share isn’t a set 30% split—it adjusts with each enrollment tier and plan.

Beyond Premiums: What You’re Actually Spending

Premiums are only one part. Most of your costs depend on how you use healthcare in a given year.

Deductibles

Plans typically reset annually, and ranges in 2025 may be:

• Low‑deductible options: $350 to $500

• High‑deductible options: $1,500 to $2,000

If you hit your deductible early in the year, services in subsequent months count toward coinsurance or copays until it resets at year’s end.

Copayments

Flat fees for visits or prescriptions may include:

• $20–$40 for primary care

• $30–$60 for specialist visits

• $50–$75 for urgent care

• $100–$150 for emergency room

Frequent or multiple provider visits can cause these to accumulate quickly.

Coinsurance

You often pay a percentage of costs after meeting the deductible:

• In-network: 10% to 30%

• Out-of-network: 40% to 50%

Large procedures or diagnostic tests can result in several hundreds to thousands in coinsurance.

Prescription Drugs

• Medicare-eligible enrollees: PSHB includes integrated Part D coverage with a maximum out-of-pocket limit of about $2,000 for prescriptions. Before hitting that cap, costs include:

  • Annual drug deductible (up to $590)

  • Tiered copays or coinsurance

• Non‑Medicare enrollees: Your prescription drug coverage may lack an out-of-pocket cap, meaning costs can escalate throughout the year.

Did You Become Medicare-Eligible? Your Cost Profile May Shift

If you’re eligible for Medicare in 2025, PSHB requires you to enroll in Medicare Part B unless certain exceptions apply. Part B premiums are about $185 per month, or $2,220 per year.

While this is an additional cost, many PSHB plans offer improved cost-sharing when coordinated with Medicare:

• Lower deductibles

• Reduced copayments and coinsurance

• Lower prescription costs for Part D drugs

This can result in a lower overall health care burden, despite paying more upfront.

Employer vs. Employee: Your Contributions in Context

Remember the federal government pays about 72% of weighted premium averages—but that doesn’t cover:

• Medicare Part B premiums (if applicable)

• Deductibles

• Copays and coinsurance

• Out-of-network charges

• Drug expenses beyond coverage limits

Combined, your annual total cost might look like this:
Premium contributions + deductible + copays + coinsurance + Medicare Part B = many thousands of dollars per year, especially if you have ongoing health needs.

Why These Costs Matter During Open Season

Open Season runs annually from November through December. It’s your chance to:

• Reassess your PSHB plan

• Shift between plan types or tiers

If you focus only on premiums, you risk overlooking medical expenses that really matter—like deductibles, coinsurance, and drug coverage. Those can vary widely between plans and significantly affect yearly spending.

High-Deductible Plans: Balance Low Premiums with Risk?

High‑deductible options may offer lower monthly premiums. But they carry increased risk if you:

• Require surgery or hospitalization

• Need ongoing specialist care

• Take costly medications

Without pairing with a Health Savings Account (HSA)—and if you’re still working—the financial hit from a major event may outweigh premium savings.

Estimating Your True Annual Costs

Use this formula as a guide:

Annual premium contribution + deductible + copays + coinsurance + Medicare Part B (if relevant) = Total estimated annual healthcare spending

Track your past usage: number of visits, whether you met deductibles, ER or hospital stays, prescriptions filled. Then use that data to project your 2025 spending.

Out-of-Pocket Maximums Provide Some Protection

PSHB plans include annual in-network out-of-pocket maximums:

• $7,500 for Self Only

• $15,000 for Self Plus One and Self and Family

These caps include deductible, copays, and coinsurance. After reaching the threshold, in-network services are fully covered for the rest of the calendar year.

However, remember:

• Premium contributions aren’t included

• Out-of-network services aren’t capped

• Medicare Part B premiums aren’t included

• Non-covered services aren’t counted

So actual spending may still exceed those caps.

Trends in Cost Shift Over Time

In 2024, FEHB premiums increased about 13.5%. In 2025, PSHB reflects similar cost pressures. The mandated Medicare eligibility expansion also introduced Part B costs for new retirees.

Ongoing trend: more costs shifting to enrollees and rising plan design complexity. It’s more important than ever to stay informed and compare thoroughly each Open Season.

How to Take Control of Your Health Spending

Here’s what you can do:

• Review your 2025 plan brochure carefully, especially cost-sharing details

• Use plan comparison tools to model total costs—not just premiums

• Track your usage monthly

• Join wellness or disease management programs where available

• Speak with a licensed agent listed on this website for personalized plan guidance

Your Real PSHB Costs Deserve a Closer Look

You see your paycheck deduction and think that’s your cost—but in reality, via deductibles, copays, coinsurance, and Medicare coordination, 2025’s total can surprise many.

You have the power to choose wisely. When you understand your full cost picture, you can:

• Select the best PSHB plan

• Prepare for what lies ahead

• Avoid unnecessary financial burden

Take the time now to evaluate your situation and plan ahead. Your health and your wallet both deserve it. If you’d like help estimating your total 2025 costs or comparing plan designs, get in touch with a licensed agent listed on this website for expert advice.