Key Takeaways
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Understanding how PSHB deductibles work can help you budget for medical expenses and avoid surprises.
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Choosing the right PSHB plan requires balancing deductibles, copays, and out-of-pocket costs to find what suits your needs best.
What Exactly Are PSHB Deductibles, and Why Should You Care?
When you enroll in a Postal Service Health Benefits (PSHB) plan, one of the first things you’ll hear about is the deductible—but what does it really mean for you? In simple terms, a deductible is the amount you pay out of pocket for covered healthcare services before your insurance kicks in to share the cost.
If your PSHB plan has a $500 deductible, for example, you’ll need to pay that amount on your own for medical care before your insurance begins covering a portion of your bills. However, deductibles don’t apply to all services—some plans cover preventive care without requiring you to meet the deductible first.
How Deductibles Fit Into Your Overall Healthcare Costs
A deductible is just one part of your total healthcare expenses. You also need to consider copayments, coinsurance, and out-of-pocket maximums. Here’s how these pieces work together:
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Deductible: The initial amount you pay before insurance contributes.
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Copayments: Fixed fees for specific services (like doctor visits).
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Coinsurance: A percentage of costs you share with your plan after meeting your deductible.
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Out-of-Pocket Maximum: The highest amount you’ll pay for covered services in a year before your insurance covers 100%.
Why This Matters
The size of your deductible affects your monthly premium and overall medical expenses. Generally:
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Lower deductibles usually mean higher monthly premiums, but you’ll pay less when you need care.
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Higher deductibles mean lower premiums, but you’ll pay more upfront for medical services before your coverage kicks in.
What Counts Toward Your PSHB Deductible?
Not every healthcare expense you pay will count toward your deductible. Here’s what typically does and doesn’t count:
✅ Counts Toward Your Deductible:
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Doctor visits (if your plan doesn’t have copays).
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Lab tests and imaging.
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Prescription drugs (in some cases).
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Hospital stays and outpatient procedures.
❌ Does Not Count Toward Your Deductible:
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Monthly premiums.
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Services with a copayment.
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Out-of-network costs beyond allowed limits.
It’s important to review your plan details so you’re not caught off guard by unexpected expenses.
Timing Matters: When Does the Deductible Reset?
Your PSHB deductible resets every calendar year on January 1. That means any expenses you’ve paid toward it in the previous year won’t roll over.
If you hit your deductible in December, it resets the next month, and you’ll start fresh in January. This timing is crucial when planning for major medical procedures. If you’ve already met your deductible late in the year, scheduling elective procedures before year-end could save you money.
Individual vs. Family Deductibles
If you’re covering dependents under your PSHB plan, your plan may have:
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Individual Deductibles: Each person must meet their own deductible before benefits apply.
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Family Deductibles: Once the combined medical expenses of all covered members reach a certain amount, the deductible is considered met for everyone.
Understanding the difference can help you budget effectively, especially for families with ongoing medical needs.
In-Network vs. Out-of-Network Deductibles
Many PSHB plans have separate deductibles for in-network and out-of-network care. Staying in-network can save you money since out-of-network services usually have higher deductibles and lower coverage percentages.
Before visiting a provider, confirm they’re in-network with your PSHB plan to avoid unexpected costs.
Making the Most of Your PSHB Plan’s Deductible
To minimize healthcare expenses, consider these strategies:
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Use Preventive Services: Many PSHB plans offer free preventive care that doesn’t count toward your deductible. Take advantage of annual checkups, screenings, and immunizations.
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Compare Costs: Before scheduling procedures, compare prices between in-network providers.
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Use a Health Savings Account (HSA) or Flexible Spending Account (FSA): If available, these accounts let you set aside pre-tax money for medical expenses, helping you cover deductible costs.
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Time Major Procedures Wisely: If you’re close to meeting your deductible, consider scheduling treatments before year-end.
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Stay In-Network: Whenever possible, choose providers within your plan’s network to avoid paying more out-of-pocket.
What Happens After You Meet Your Deductible?
Once you’ve paid your full deductible, your insurance will start covering a portion of costs. At this point, coinsurance and copayments apply until you hit your out-of-pocket maximum.
Once you reach the out-of-pocket maximum, your PSHB plan will cover 100% of covered healthcare costs for the rest of the year.
Choosing a PSHB Plan That Works for You
When selecting a PSHB plan, consider your healthcare usage, financial situation, and risk tolerance:
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If you rarely need medical care, a high-deductible plan with lower premiums might save you money.
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If you expect frequent doctor visits or ongoing treatments, a lower deductible plan with higher premiums could be the better choice.
Planning Ahead for PSHB Open Season
PSHB Open Season runs from November 11 to December 13, 2025, giving you a chance to review and change your plan based on your healthcare needs. Use this period to compare deductibles, premiums, and coverage to find the best fit.
Why Understanding Your PSHB Deductible Matters
Your PSHB deductible directly affects how much you’ll pay out-of-pocket for medical care. Being informed about how it works—along with copays, coinsurance, and out-of-pocket maximums—helps you make smart healthcare decisions and budget effectively.
To get personalized guidance, reach out to a licensed agent listed on this website. They can help you compare plans and find the best option for your needs.
