Key Takeaways

• PSHB coinsurance is an ongoing cost-sharing percentage that can lead to unexpectedly high out-of-pocket expenses—especially for retirees managing fixed incomes.

• Understanding when and how coinsurance applies in 2025 can help you avoid financial surprises during major health events.

What Coinsurance Means Under PSHB in 2025

Coinsurance is not a flat fee. It’s a percentage you pay for medical services after meeting your plan’s deductible. For many enrollees in the Postal Service Health Benefits (PSHB) Program, coinsurance rates range from 10% to 30% for in-network care and can climb significantly for out-of-network services. This cost-sharing kicks in after you’ve met your annual deductible.

It sounds manageable until you realize that medical procedures can cost thousands of dollars, and your share is tied to that total. If you’re hospitalized, need ongoing specialist care, or require expensive treatments, even a 20% coinsurance rate can leave you with a sizeable bill.

Why These Costs Catch People Off Guard

In the old FEHB world, some plans focused more on copayments, which are flat, predictable fees. Now under PSHB in 2025, coinsurance is more common—and more variable. You might not realize how much of your medical costs you’re still responsible for until the Explanation of Benefits (EOB) shows up weeks later.

Coinsurance doesn’t apply only to major events either. Imaging tests, outpatient surgeries, physical therapy, and durable medical equipment often fall under coinsurance rules. The cumulative impact of these services over the year can be substantial.

When Coinsurance Starts and How It Works

To activate coinsurance, you must first pay your plan’s deductible. For low-deductible PSHB plans in 2025, this may range between $350 and $500 for in-network care. High-deductible options can run between $1,500 and $2,000 or more.

Once that deductible is met, your plan begins sharing costs with you:

• For in-network services, coinsurance generally ranges from 10% to 30%.

• For out-of-network care, the rate may jump to 40% or even 50%.

Unlike copays, which remain the same regardless of the service cost, coinsurance scales with the price of care. A $4,000 outpatient procedure with a 20% coinsurance rate means you’re paying $800 out of pocket—even after you’ve met your deductible.

In-Network vs. Out-of-Network Care: A Cost Multiplier

One of the easiest ways to rack up coinsurance costs is by unknowingly going out-of-network. Even if your primary doctor is in-network, the specialist they refer you to or the lab processing your test might not be.

In 2025, PSHB plans require more vigilance from you. Always confirm provider networks before scheduling care, especially for surgery, diagnostics, or specialty care. Out-of-network coinsurance isn’t just higher—those services may also be billed at higher rates to begin with, compounding your out-of-pocket burden.

Annual Out-of-Pocket Maximums Offer a Safety Net

Here’s the silver lining: PSHB plans include out-of-pocket maximums. For in-network care, the limit is $7,500 for Self Only and $15,000 for Self Plus One or Self & Family. Once you hit that cap, the plan pays 100% of eligible in-network expenses for the rest of the year.

However, that cap only applies to covered in-network expenses. If you stray outside the network, you may still face high bills, and those costs may not count toward your in-network maximum. It’s also important to note that the deductible, coinsurance, and copayments all contribute toward that annual limit.

How Medicare Coordination Affects Coinsurance

If you’re a retiree enrolled in both PSHB and Medicare Part B, your out-of-pocket exposure is often lower. Many PSHB plans waive or reduce deductibles and coinsurance if you have Medicare Part B in place. This coordination can significantly soften the financial blow of hospital stays, specialist visits, and lab work.

That said, not all PSHB plans offer identical cost-sharing benefits for Medicare enrollees. In 2025, the integration benefits vary by plan, so it’s crucial to compare options carefully during Open Season each November and December.

High-Cost Scenarios to Watch For

Even when you plan carefully, certain services under PSHB tend to trigger steep coinsurance bills:

• Outpatient surgeries such as cataract removal or joint injections.

• Advanced diagnostic imaging (MRIs, PET scans, CT scans).

• Specialist care that extends beyond a few visits.

• Chemotherapy, infusion therapy, and biologics.

• Skilled nursing care after a hospital stay.

• Rehabilitation services including physical and occupational therapy.

These are often essential services—not optional—and coinsurance applies every time.

What You Can Do to Prepare

Rather than being blindsided, here are smart steps to help manage coinsurance in 2025:

• Check plan details before receiving care. Ask if the service will involve coinsurance and get an estimate.

• Stick to in-network providers. Every out-of-network encounter can drastically raise your share of costs.

• Know your deductible status. If you haven’t met it yet, you’ll be paying full price until you do.

• Track your out-of-pocket spending. Most plans have a portal where you can monitor where you stand.

• Review plan options annually. During Open Season, evaluate whether your current coinsurance rates and maximums still make sense for your situation.

• If eligible, coordinate with Medicare. It can reduce your cost-sharing and extend coverage.

The Impact on Retirees Is Especially Strong

If you’re a postal retiree living on a fixed income, coinsurance can be particularly stressful. It’s hard to budget for percentages—especially when you’re unsure how high the underlying bill will be.

In 2025, with healthcare costs continuing to rise, the difference between a flat copay and variable coinsurance is more than just semantics. It’s a budgeting challenge that requires proactive planning and deep familiarity with your plan.

A Quick Word on Emergency Care

Emergency room visits and urgent care can involve coinsurance, too. If your PSHB plan lists a flat fee for the ER, that might only apply to the facility. You could still owe coinsurance for the doctors, imaging, labs, and treatments you receive while you’re there.

Always double-check your plan brochure to understand which components of emergency care are subject to coinsurance. In urgent situations, there’s no time to shop around—but knowing the financial layout ahead of time gives you more control when the bill arrives.

Don’t Let Coinsurance Be an Unpleasant Surprise

The best way to manage PSHB coinsurance in 2025 is by being alert, proactive, and informed. These aren’t hidden fees—they’re spelled out in your plan. But when you’re caught up in a medical issue, the fine print is the last thing on your mind.

Make it a habit to ask about coinsurance before care. Review your Explanation of Benefits. Use the member portal. These steps won’t eliminate the costs, but they will make them more predictable.

Stay Ahead of Cost-Sharing Before It Hits Your Wallet

Coinsurance under PSHB can quietly erode your savings if you don’t prepare for it. With smart planning, you can avoid surprises and feel more confident about your healthcare costs in 2025. Take the time to learn what your plan covers and what it doesn’t.

For help evaluating your plan options or understanding your coinsurance responsibilities, reach out to a licensed insurance agent listed on this website.