Key Takeaways

• If you’re eligible for Medicare and enrolled in a PSHB plan in 2025, enrolling in Medicare Part B is a requirement to maintain full coverage.

• Failing to enroll in Part B could lead to gaps in your PSHB benefits and higher out-of-pocket costs, especially for outpatient services.

Understanding the New Requirement for PSHB and Medicare Part B

As of 2025, the Postal Service Health Benefits (PSHB) Program operates with a critical link to Medicare Part B. If you’re a postal retiree—or a family member of one—who’s Medicare-eligible, enrolling in Part B is no longer a decision you can delay or skip. It’s now a required step to ensure your PSHB plan works the way it’s designed to.

This change stems from the 2022 Postal Service Reform Act, which officially transitioned USPS health coverage from the Federal Employees Health Benefits (fehb) Program to the PSHB Program starting January 1, 2025. And with it came a major shift: the integration of Medicare Part B into your postal retiree healthcare.

Who Must Enroll in Part B

The PSHB Medicare enrollment requirement applies to:

• Postal retirees who are age 65 or older

• Covered family members who are 65 or older

• Medicare-eligible annuitants and family members due to disability

However, there are specific exemptions to this rule:

• If you retired on or before January 1, 2025 and are not enrolled in Medicare Part B, you are not required to enroll.

• If you were actively working for USPS and were 64 or older on January 1, 2025, you are exempt.

• If you live overseas or qualify for VA or Indian Health Services, you may also be exempt.

If none of these apply to you, then enrolling in Part B is not optional.

What Happens If You Don’t Enroll

The consequence of skipping Part B is simple but serious: your PSHB plan will not provide full benefits.

Without Part B, your PSHB plan may act like a secondary payer—or in some cases, not pay for certain services at all. That means you could face steep out-of-pocket costs for things that would otherwise be covered if Part B were in place.

Services most affected include:

• Doctor visits

• Outpatient surgeries

• Physical therapy

• Durable medical equipment

Additionally, you might be locked out of certain prescription drug coverage features. Most PSHB plans coordinate with Medicare Part D through a separate but automatic enrollment in an Employer Group Waiver Plan (EGWP). If you’re not enrolled in Part B, you could lose access to this as well.

Why the Rule Exists in 2025

The mandatory enrollment rule was introduced to:

• Ensure better coordination between Medicare and PSHB

• Reduce the financial burden on the PSHB program

• Align with standard Medicare coordination policies that other federal retirees have followed for years

Before 2025, FEHB members could delay Part B enrollment with fewer consequences. But under PSHB, your Part B status is checked to determine if your health plan can fully activate its benefits.

Timing and Enrollment Windows

If you’re approaching age 65 in 2025, you have a 7-month Initial Enrollment Period (IEP):

• Starts 3 months before your 65th birthday month

• Includes your birthday month

• Ends 3 months after your birthday month

If you miss that window, the General Enrollment Period (GEP) runs from January 1 to March 31 each year. Coverage starts July 1, but a late enrollment penalty may apply.

For those impacted by the PSHB transition and not previously enrolled in Part B, a Special Enrollment Period (SEP) ran from April 1 to September 30, 2024. This allowed eligible retirees to sign up for Part B without a penalty. That SEP is now over, so your only enrollment opportunity may be the GEP.

Costs to Consider

While most people pay the standard premium for Part B, the actual cost depends on your income. In 2025:

• The standard premium is $185/month

• The annual deductible is $257

Higher-income individuals may pay more due to Income-Related Monthly Adjustment Amounts (IRMAA). But not having Part B could cost even more through unpaid medical bills and non-covered services.

Some PSHB plans offer premium reimbursements or other cost-saving incentives if you enroll in Medicare. However, those benefits only kick in after you enroll in Part B.

What Your PSHB Plan Does With Part B

When you have both Part B and a PSHB plan, they coordinate to minimize your costs:

• Medicare pays first for covered outpatient services

• PSHB pays second, often covering what Medicare does not

• You may pay nothing out-of-pocket for certain services when both are active

With this coordination, your overall healthcare becomes more predictable and less expensive. It also enhances your prescription drug coverage by unlocking Part D-related benefits embedded in your PSHB plan.

Prescription Drug Coverage Tied to Part B

Many PSHB plans include automatic enrollment into a Medicare Part D Employer Group Waiver Plan (EGWP). This works seamlessly only if you have Medicare Part B. If you don’t enroll in Part B, your plan may exclude you from this benefit.

The Part D features you could lose without Part B include:

• An annual $2,000 out-of-pocket cap on prescription drugs

• Access to the Medicare Prescription Payment Plan, which allows you to spread drug costs over time

• A broader pharmacy network

Skipping Part B means giving up these safeguards, and you may end up paying significantly more for your prescriptions.

How to Enroll in Part B in 2025

If you haven’t yet enrolled and now need to, here are your options:

• Online: Visit the Social Security website to apply directly

• By Phone: Call Social Security at 1-800-772-1213

• In Person: Visit a local Social Security office (appointments are recommended)

Be prepared with documents such as your birth certificate, proof of USPS retirement, and prior Medicare statements (if applicable).

Staying Covered: Why Part B Matters Long-Term

Enrolling in Medicare Part B ensures long-term access to a well-integrated health coverage system. For PSHB retirees, the pairing of Medicare and your PSHB plan isn’t just convenient—it’s financially necessary.

Without Part B, not only does your PSHB plan scale back, but your ability to manage chronic conditions, specialist visits, and outpatient care becomes more complicated and expensive.

In the long run, having both ensures:

• Peace of mind about cost-sharing

• Protection from coverage gaps

• Access to enhanced pharmacy and specialist networks

Act Now to Protect Your PSHB Benefits

Now that the PSHB Program is fully active in 2025, enrolling in Medicare Part B is the single most important action you can take if you’re Medicare-eligible. Don’t risk reduced benefits or costly gaps in coverage. Whether you’re newly eligible or reviewing your plan, it’s time to ensure your Part B enrollment is active and up-to-date.

If you need help understanding what this means for your specific situation, get in touch with a licensed insurance agent listed on this website.