Key Takeaways

• Your deductible plays a critical role in how much you actually pay out-of-pocket under your PSHB plan. Even with good coverage, reaching your deductible can mean hundreds or even thousands in upfront medical expenses before full benefits kick in.

• Many enrollees focus only on premiums and copayments, but failing to plan for the deductible can lead to financial strain, especially in high-use years. Understanding your deductible now can help you budget better and avoid costly surprises.

What Exactly Is a Deductible in PSHB?

Under the Postal Service Health Benefits (PSHB) Program, your deductible is the amount you must pay out-of-pocket each year for certain covered services before your plan starts sharing the cost. This includes things like lab work, outpatient procedures, diagnostic imaging, and sometimes specialist visits.

In-network deductibles for 2025 typically range from $350 to $500 for low-deductible plans, and from $1,500 to $2,000 for high-deductible options. Out-of-network deductibles are significantly higher, reaching as much as $3,000 in some cases.

What matters is that until you meet your deductible, many services you assume are covered may be billed at full price to you.

Why the Deductible Feels Invisible—Until It Isn’t

It’s easy to overlook the deductible because it only shows up when you actually use your coverage beyond routine visits. If you have a healthy year, you might never notice it. But in a year when you need:

• A series of lab tests

• Imaging like an MRI or CT scan

• A minor outpatient procedure

• Frequent specialist care

…that deductible suddenly moves front and center.

Unlike copayments, which are fixed, the deductible functions like a gate. Until it’s met, you’re responsible for the full cost of eligible services. And since some services are expensive, you could burn through your budget early in the year without realizing it.

How the Deductible Interacts with Other Costs

Understanding how your deductible fits into the broader cost structure of your PSHB plan helps you plan ahead. Here are the key cost components:

• Premiums: The amount you pay every month to maintain your coverage.

• Copayments: Flat fees for common services like doctor visits and prescriptions.

• Coinsurance: A percentage of the cost you pay after meeting your deductible.

• Deductible: What you pay first before coinsurance kicks in.

So if your plan lists a 20% coinsurance rate and you haven’t met your deductible yet, you don’t get the 80/20 split benefit. You pay 100% until you hit the deductible amount. Only then does coinsurance apply.

High vs. Low Deductible Plans: What You Need to Know

In 2025, PSHB enrollees typically choose between low-deductible and high-deductible plans. Each comes with trade-offs:

Low-Deductible Plans

• Lower out-of-pocket cost early in the year

• Higher monthly premiums

• Better for individuals with ongoing health needs

High-Deductible Plans

• Lower premiums

• Higher out-of-pocket costs when care is needed

• Often paired with a Health Savings Account (HSA) for tax-free savings

If you rarely need care, a high-deductible plan may look more affordable. But if unexpected care arises—a surgery, multiple specialist visits, or diagnostic scans—you may find yourself paying $1,500 to $2,000 before the plan starts covering most of the bills.

You May Reach the Deductible Faster Than You Expect

Many people underestimate how quickly costs can accumulate. Consider just a few scenarios that can eat into your deductible quickly:

• Imaging: MRIs can cost between $1,000 and $2,000.

• Outpatient procedures: Colonoscopies, biopsies, or minor surgeries can run from $1,200 to $3,500.

• Specialist visits: Especially when lab work or diagnostics are involved, these can total several hundred dollars each.

In other words, even one moderate health event early in the year can push you past your deductible.

Retirees Often Bear a Bigger Burden

For retirees under PSHB in 2025, the deductible hits differently. While active USPS employees benefit from employer cost-sharing that covers about 72% of premiums, retirees have to shoulder more of the load.

• Annuitant premiums are lower in dollar terms, but retirees don’t receive the same wage-based assistance.

• Medical events tend to increase with age, making it more likely you’ll reach your deductible every year.

If you’re a Medicare-eligible retiree and enrolled in both PSHB and Medicare Part B, some plans coordinate benefits to reduce your deductible or waive it altogether. But not all plans do. You must check your plan brochure.

Deductibles for Out-of-Network Care Are Even Steeper

Staying in-network is crucial if you want to manage your costs. Out-of-network deductibles are often double or triple the in-network amount. In 2025, out-of-network deductibles can be as high as $3,000.

That means:

• You pay the full out-of-network deductible first

• After meeting that, you may face 40% to 50% coinsurance

• Many services may not be covered at all

The PSHB network directories and plan brochures are your best tools to ensure your preferred providers are in-network. Otherwise, a $300 procedure could cost you closer to $1,000 out of pocket.

How Medicare Coordination Changes the Equation

If you’re Medicare-eligible in 2025 and enrolled in Part B, many PSHB plans offer special coordination benefits:

• Waived deductibles

• Reduced coinsurance

• Lower copayments

Some even reimburse part of your Part B premium, further easing your cost burden.

But coordination is not automatic across all plans. If you opted out of Part B, or your plan doesn’t include enhanced coordination, the deductible will remain in place.

Understanding your plan’s Medicare integration is essential. The wrong assumption can leave you exposed to thousands in unexpected costs.

Timing Matters: When You Use Care Affects How the Deductible Feels

Because deductibles reset each calendar year, the timing of medical services can create a financial bottleneck:

• January to March: You may not have met your deductible yet, so services are more expensive.

• April to September: You may be midway through, depending on your usage.

• October to December: If you’ve met your deductible, take advantage of cost-sharing while it lasts.

This timing issue can be especially frustrating if you delay care and bunch appointments into the first quarter of the year. Budgeting for the first few months can ease the shock.

What to Do If You Can’t Afford Your Deductible

If your plan comes with a higher deductible and you find yourself unable to cover those early costs, consider these options:

• Use an HSA or FSA if available. Funds are pre-tax and can pay for deductible expenses.

• Ask providers for payment plans, especially for high-cost services like imaging or outpatient surgery.

• Bundle appointments later in the year after meeting your deductible to minimize extra spending.

Also, during Open Season (November to December), review whether your current plan matches your health and financial situation. If not, switching may lower your out-of-pocket exposure for the following year.

Why Reviewing the Deductible Is More Important Than Ever in 2025

Healthcare costs have continued to rise in 2025. Even though PSHB offers extensive coverage, you’re still expected to carry part of the burden. With more enrollees aging into Medicare and more plans offering high-deductible options, failing to account for the deductible is a costly oversight.

Use your plan’s Summary of Benefits and Coverage (SBC) and the official PSHB website to:

• Find your exact deductible amount

• Understand what services it applies to

• Check if Medicare enrollment affects your cost sharing

This is not a footnote. This is one of the most critical pieces of your 2025 healthcare budget.

Budgeting for the Deductible in Your Annual Health Plan

To prepare, start with these steps:

• Estimate your expected care: Include appointments, tests, procedures, and pharmacy needs.

• Factor in the deductible amount: If your health needs are moderate to high, expect to meet the full deductible.

• Build it into your emergency fund: Treat it like any other financial obligation.

For retirees, this is even more critical. Your fixed income means unplanned expenses can derail your financial stability.

Don’t Let the Deductible Catch You Off Guard

The deductible is quiet. It doesn’t show up in your premium notice. It’s not printed on your PSHB ID card. But the moment you need care beyond routine visits, it can become one of the largest out-of-pocket expenses you face.

Review your 2025 PSHB plan documents. Talk to a licensed agent listed on this website for a full breakdown of how your deductible works and how to prepare for it. With the right planning, you can stay in control of your healthcare finances.