Key Takeaways

• Understanding PSHB costs is essential for making informed healthcare decisions. Knowing your premiums, deductibles, and cost-sharing amounts can help you budget effectively.

• The government covers a portion of your PSHB premium, but you are responsible for the remaining costs. Evaluating coverage details ensures you choose a plan that fits your needs.

Breaking Down PSHB Costs: What You Pay and What’s Covered

Postal Service Health Benefits (PSHB) offer extensive coverage, but understanding the financial aspects is key to making the right choice for you and your family. From premiums to out-of-pocket costs, knowing where your money goes helps you maximize your benefits while keeping expenses under control.

How PSHB Premiums Work

Your PSHB premium is the monthly amount you pay to maintain health coverage. The government contributes a portion, reducing your out-of-pocket expenses, but the rest falls on you. The exact amount depends on your selected plan and coverage type—Self Only, Self Plus One, or Self and Family.

Government Contributions and Your Share

As a postal employee or annuitant, you benefit from significant government contributions toward your PSHB premium. The government covers roughly 70% of the total premium cost, leaving you responsible for the remaining 30%. This support makes PSHB coverage more affordable compared to many private-sector plans.

However, it’s important to review plan details carefully. Premiums vary depending on the benefits offered, and higher-cost plans often include more comprehensive coverage. If affordability is a concern, comparing plans based on both cost and coverage ensures you get the most value for your money.

Understanding Deductibles: What You Pay Before Coverage Kicks In

A deductible is the amount you must pay out of pocket before your PSHB plan starts covering certain medical expenses. Deductibles vary based on the plan you choose, with lower-deductible plans generally having higher premiums and vice versa.

High-Deductible vs. Low-Deductible Plans

• High-deductible plans typically have lower monthly premiums but require you to pay more upfront for medical services before insurance kicks in.

• Low-deductible plans come with higher premiums but reduce your initial out-of-pocket expenses when receiving care.

If you anticipate frequent medical visits, a low-deductible plan may save you money in the long run. On the other hand, if you’re generally healthy and don’t expect many medical expenses, a high-deductible plan might be a more cost-effective option.

Co-Pays and Coinsurance: The Cost of Care

Once you meet your deductible, your plan shares the cost of covered services. This is done through co-pays and coinsurance:

• Co-pays are fixed amounts you pay for specific services, such as doctor visits, prescriptions, and urgent care visits.

• Coinsurance is a percentage of the total cost of a covered service that you pay after meeting your deductible.

For example, if your plan has a 20% coinsurance rate and you receive a medical service that costs $500, you would pay $100 (20%), and your insurance would cover the rest.

Out-of-Pocket Maximums: Your Safety Net

Every PSHB plan has an out-of-pocket maximum, which is the most you’ll pay in a year before your plan covers 100% of covered services. This includes deductibles, co-pays, and coinsurance but excludes premiums.

For 2025, PSHB out-of-pocket maximums are set at $7,500 for Self Only and $15,000 for Self Plus One and Self & Family plans when using in-network providers. Once you reach this limit, your plan takes over, covering all additional covered medical expenses for the rest of the year.

The Role of Medicare in PSHB Costs

If you’re a Medicare-eligible postal retiree, coordinating PSHB with Medicare Part B can lower your out-of-pocket costs. Many PSHB plans offer additional savings for enrollees who have Medicare, including waived deductibles and lower co-pays.

If you retired before January 1, 2025, you are not required to enroll in Medicare Part B to keep your PSHB coverage. However, if you retire after this date, Medicare Part B enrollment is mandatory for continued PSHB eligibility.

Prescription Drug Costs Under PSHB

PSHB plans include prescription drug coverage, but costs vary depending on the specific plan. In 2025, a new $2,000 cap on out-of-pocket prescription drug costs ensures that beneficiaries do not spend excessively on medications.

Most PSHB plans use a tiered pricing system, meaning lower-cost generic drugs will have smaller co-pays, while brand-name and specialty drugs will have higher costs. Reviewing each plan’s formulary can help you estimate your prescription costs more accurately.

Emergency Care and Specialty Services: What You Need to Know

Emergency room visits, specialist care, and hospital stays can be expensive, but PSHB plans help manage these costs through co-pays and coinsurance. Typically:

• Emergency room visits may require a co-pay of $100-$150 per visit.

• Specialist visits may have a co-pay of $30-$60.

• Inpatient hospital stays involve a combination of deductibles, co-pays, and coinsurance.

Using in-network providers significantly reduces costs. Out-of-network services often come with higher cost-sharing amounts, making it essential to check provider networks before seeking care.

Preventive Care: Free or Low-Cost Services

PSHB plans fully cover many preventive services, meaning you can access routine check-ups, vaccinations, and screenings at no cost. These services help catch health issues early, reducing the need for more expensive treatments later on.

Covered preventive services typically include:

• Annual wellness exams

• Cancer screenings (such as mammograms and colonoscopies)

• Flu shots and other vaccinations

• Blood pressure and cholesterol checks

Taking advantage of these services helps you stay healthy while minimizing medical costs over time.

Making Smart Choices for Your Health Coverage

Choosing the right PSHB plan depends on your healthcare needs and financial situation. Consider factors such as:

• Premium vs. out-of-pocket costs: Balancing monthly payments with potential healthcare expenses.

• Provider networks: Ensuring your preferred doctors and hospitals are covered.

• Prescription drug coverage: Checking if your medications are included in the plan’s formulary.

• Coordination with Medicare: Maximizing benefits if you’re eligible.

Reviewing these elements each year helps you select a plan that aligns with your healthcare priorities and budget.

Get Help Choosing the Right Plan

Navigating PSHB costs and coverage options can be complex, but you don’t have to do it alone. A licensed agent listed on this website can help you compare plans, understand cost structures, and make an informed decision that suits your needs.