Key Takeaways

• Medicare Advantage plans often appear appealing but may come with significant limitations in coverage flexibility, provider access, and out-of-pocket costs that are especially important for PSHB enrollees to understand.

• If you’re eligible for Medicare and covered under the Postal Service Health Benefits (PSHB) Program, coordinating your PSHB plan with Original Medicare may offer more predictable and comprehensive benefits than relying solely on a Medicare Advantage plan.

Medicare Advantage: Why It Sounds Good at First

Medicare Advantage (Part C) is often marketed as a one-stop-shop for healthcare needs. It promises to combine Medicare Part A and Part B with additional benefits that seem too good to ignore. From bundled coverage to potential extras like dental or hearing care, the brochures paint a bright picture.

But what they don’t always tell you is what happens behind that appealing surface—especially if you’re a Postal Service annuitant or eligible for the PSHB Program in 2025. What you think you’re getting and what you’re actually signing up for can be two very different things.

The Tradeoff: Managed Care vs. Freedom of Choice

Unlike Original Medicare, which allows you to see nearly any provider who accepts Medicare, Medicare Advantage plans operate within managed care networks.

These networks often require:

• Prior authorizations for services like MRIs, rehab stays, or even outpatient surgeries

• Referrals before seeing specialists

• Limited provider choices based on narrow regional networks

For PSHB participants accustomed to broader provider access, these restrictions can feel limiting, even jarring. What may seem like a unified plan can actually mean less control over your healthcare decisions.

Out-of-Pocket Costs: Predictability Matters

Medicare Advantage plans typically set an annual maximum out-of-pocket (MOOP) limit, which may sound reassuring. However, these limits can be as high as $9,350 for in-network services and $14,000 for combined in-network and out-of-network services in 2025.

In practice, that means if you become seriously ill or require specialized care, your annual financial exposure could be significant. Add in coinsurance, copayments, and surprise costs for out-of-network care, and your budget may take a serious hit.

By contrast, many PSHB plans that coordinate with Original Medicare Part B offer benefits like:

• Reduced or waived deductibles

• Lower coinsurance

• Predictable copays

The result? A more stable and transparent cost structure.

Hidden Costs of Supplemental Benefits

One of the main selling points of Medicare Advantage plans is the inclusion of supplemental benefits, such as:

• Routine dental care

• Hearing aids

• Eyeglasses

• Over-the-counter drug allowances

But in 2025, many of these benefits come with:

• Limited networks of providers (if any)

• Restrictions on frequency and amount of services

• Reductions in availability, particularly for benefits like transportation or fitness programs

These perks are not guaranteed and can be dropped, capped, or significantly altered from year to year. That unpredictability can interfere with long-term health planning.

PSHB Coordination with Medicare Part B: A Strategic Advantage

If you’re a Postal Service annuitant enrolled in both PSHB and Medicare Part B, you may enjoy more streamlined coverage without the hidden pitfalls of Medicare Advantage plans. Many PSHB plans in 2025 offer:

• Automatic coordination of benefits with Medicare Part B

• Fewer requirements for prior authorization

• Simplified claims processing

• Integrated prescription drug coverage through Medicare Part D EGWP (Employer Group Waiver Plan)

This dual-coverage model typically reduces administrative burden while ensuring you still have access to robust nationwide networks.

Coverage Changes and Annual Review Requirements

Every fall, Medicare Advantage enrollees receive the Annual Notice of Change (ANOC). This document outlines changes in coverage, copayments, provider networks, and benefits.

Failing to review this document carefully can result in unintended gaps in care. Even those who are happy with their plan one year may find the next year’s version less compatible with their needs.

With PSHB plans coordinated with Original Medicare, coverage and cost structures are generally more consistent year-to-year, reducing the risk of sudden disruptions.

Prescription Drug Costs: Know Where You Stand

Medicare Advantage plans include drug coverage, but not all formularies are the same. These plans often use tiered pricing systems that can shift annually. The introduction of the $2,000 out-of-pocket cap under Medicare Part D in 2025 offers significant relief, but how that integrates with your plan can vary.

PSHB plans with EGWP prescription drug coverage typically offer:

• Broader access to medications

• Simplified refill processes

• Cost protections once you reach the out-of-pocket threshold

If you depend on medications, understanding how those costs will be handled matters more than ever.

Emergency and Urgent Care: Travel Complications

Medicare Advantage plans often restrict coverage to specific geographic areas, which becomes a serious drawback if you travel frequently or live in different locations during the year.

While emergency care is generally covered, urgent care or follow-ups outside your plan’s service area might not be. This can affect:

• Snowbirds who split time between states

• Retirees visiting family

• Postal retirees who relocate after retirement

Original Medicare with PSHB offers more consistent national coverage—which means fewer hassles when you’re away from home.

Referrals and Authorizations: Delays in Care

The need for prior authorizations is one of the most controversial aspects of Medicare Advantage. While intended to control costs, the result is often delayed or denied care.

Common services subject to delays include:

• Physical therapy

• MRIs and CT scans

• Outpatient surgeries

• Skilled nursing facility stays

For PSHB members, particularly those managing chronic conditions or recovering from illness, such delays can impact your recovery or health outcomes.

PSHB plans paired with Original Medicare typically reduce or eliminate the need for these delays, allowing your care to progress without administrative obstacles.

Enrollment and Switching: Limited Windows, High Stakes

Medicare Advantage enrollees are generally locked into their plan for the calendar year unless they qualify for a Special Enrollment Period (SEP). While there is an Annual Open Enrollment Period from October 15 to December 7, missing it could mean being stuck with a plan that no longer meets your needs.

If you’re in the PSHB Program and coordinating with Original Medicare, you often retain more flexibility to adapt your plan or enroll in coverage that supports your full range of healthcare needs.

In 2025, Medicare-eligible PSHB annuitants also benefit from:

• Enhanced integration with Medicare Part B

• Special coordination rules that protect access and cost coverage

• Simpler transitions between plan options during Open Season

What You Gain with PSHB and Original Medicare

If you’re trying to decide whether to stick with your PSHB plan coordinated with Original Medicare or jump to a Medicare Advantage plan, here’s what you stand to gain by staying where you are:

• Nationwide coverage without network restrictions

• No referrals needed for specialist visits

• Fewer billing surprises due to automatic coordination

• Consistent benefits with limited plan disruption

And because PSHB plans are designed for Postal retirees, they understand your needs better than any off-the-shelf private Medicare Advantage plan ever will.

Making the Smart Move for Your Healthcare Future

Medicare Advantage plans might look impressive in promotional materials, but the fine print reveals their limitations. For PSHB annuitants, those limitations can mean:

• Delayed access to care

• Higher long-term costs

• Compromised provider access

• Frustration with network and authorization restrictions

Coordinating your PSHB coverage with Original Medicare offers you not just peace of mind, but clarity and consistency as well.

If you’re unsure about the best move, get in touch with a licensed agent listed on this website for professional guidance tailored to your unique situation.