Key Takeaways

• The monthly premium is only one part of what you’re truly paying under the PSHB program. Copays, coinsurance, deductibles, and contribution shares can significantly raise your total costs.

• Understanding the hidden costs and government contribution structure in 2025 can help you avoid unpleasant surprises and choose a plan that meets your budget and healthcare needs.

What You See Isn’t What You Pay

When you look at a Postal Service Health Benefits (PSHB) plan for 2025, your eyes likely go straight to the premium. But while that monthly number is an important part of your healthcare costs, it’s far from the full picture. What often escapes notice are the additional costs that quietly accumulate throughout the year—sometimes adding up to thousands more than you expected.

In 2025, as the PSHB system continues its transition away from the FEHB system, it’s especially important for USPS workers and annuitants to look beyond the surface of their plan brochures.

The Government Contribution: What You’re Really Paying

The Office of Personnel Management (OPM) determines the government’s share of your PSHB premiums. For 2025, the government covers approximately 70% of the total premium cost. That means you’re responsible for the remaining 30%, which can vary widely depending on your selected coverage level:

• Self Only

• Self Plus One

• Self and Family

If you don’t pay attention to the actual total premium (not just your share), you may underestimate how much the plan costs overall and how much more you might pay in out-of-pocket costs.

Monthly Premiums vs. Biweekly Deductions

Many Postal Service employees are paid biweekly, and your health insurance contributions come out of each paycheck. It’s easy to lose track of your actual monthly contribution. For example, if your biweekly deduction is $240, you’re really paying over $520 a month.

Understanding this difference is important when you’re budgeting, especially if you’re coordinating with other benefits like TSP contributions or retirement savings.

Hidden Cost #1: Deductibles

A deductible is the amount you must pay each year before your plan starts covering certain services. In 2025, deductibles for PSHB plans vary widely:

• Low-deductible plans may start around $350 for Self Only coverage.

• High-deductible health plans (HDHPs) can have deductibles exceeding $1,500.

Some plans count prescription drug costs toward the deductible, while others do not. Failing to account for the deductible means you might think your plan is more affordable than it truly is.

Hidden Cost #2: Copayments

Copays sound simple: a flat fee for services like doctor visits, specialists, or urgent care. But if you see multiple providers, specialists, or therapists, these fees can pile up.

In-network copays in PSHB plans typically range as follows:

• Primary care: $20 to $40 per visit

• Specialist visits: $30 to $60 per visit

• Urgent care: $50 to $75

• Emergency room: $100 to $150

If you’re visiting providers regularly, these costs can double or triple what you initially expected.

Hidden Cost #3: Coinsurance

Coinsurance means you split the cost of services with your plan, often after you’ve met your deductible. In 2025, coinsurance in PSHB plans varies by network:

• In-network services: 10% to 30%

• Out-of-network services: 40% to 50%

Let’s say you need a diagnostic test that costs $1,000. Even with in-network coverage, your share might be $200 to $300 if coinsurance applies. If you go out-of-network, your cost could jump to $500 or more.

Out-of-Pocket Maximums Aren’t Always a Safety Net

You may feel reassured knowing your plan has an annual out-of-pocket maximum. In 2025, many PSHB plans cap your in-network out-of-pocket costs at around $7,500 for Self Only and $15,000 for Self Plus One or Self and Family.

But that protection only kicks in after you’ve paid thousands in deductibles, copays, and coinsurance. And many plans have separate out-of-network maximums—which may not count toward your in-network cap.

Also, premiums don’t count toward this limit.

Prescription Drug Costs in 2025

Postal retirees and Medicare-eligible family members receive drug coverage through an integrated Medicare Part D plan. For 2025, the major change is the $2,000 out-of-pocket cap on covered prescription drug costs.

However, if you’re not enrolled in Medicare, your PSHB plan‘s regular pharmacy benefit applies. These benefits often include:

• Tiered copays or coinsurance

• Separate deductibles for prescriptions

Out-of-pocket drug costs can escalate quickly if you take non-preferred or specialty medications.

Extra Costs When Medicare Isn’t Involved

If you or your spouse is eligible for Medicare Part B but haven’t enrolled, some PSHB plans may not waive cost-sharing the way they would for those who are enrolled. That could mean higher copays, deductibles, or coinsurance.

Additionally, some plans offer Medicare Part B premium reimbursements and lower pharmacy costs to enrollees who coordinate both.

Skipping Medicare enrollment could leave you with a higher total cost burden under PSHB.

The Cost of Going Out-of-Network

PSHB plans typically offer nationwide coverage, but that doesn’t mean every provider is in-network. If you visit an out-of-network provider, expect significantly higher cost-sharing:

• Higher deductibles (often $1,000 to $3,000)

• Higher coinsurance (up to 50%)

• Separate, higher out-of-pocket limits

Even one out-of-network procedure or hospitalization can add thousands to your annual healthcare costs.

Are High-Deductible Plans Really Saving You Money?

Many Postal employees are tempted by high-deductible PSHB plans because of their lower premiums. But in 2025, with rising healthcare costs, a high-deductible plan could actually be more expensive over the course of the year.

Before choosing an HDHP, ask yourself:

• Do I expect frequent medical visits?

• Do I or my family members take regular medications?

• Can I afford to cover the full deductible out-of-pocket if needed?

If you can’t confidently answer yes to all three, the “savings” might be misleading.

Family Coverage Has a Cost Ripple Effect

Switching from Self Only to Self Plus One or Self and Family drastically increases your biweekly premium. But it also shifts your plan’s deductible, coinsurance, and out-of-pocket maximums upward.

In 2025, a Self Plus One plan might have a $1,200 deductible and a $12,000 out-of-pocket maximum. If both members use healthcare services regularly, your real cost might be double what you’d estimated based on premium alone.

Why Reviewing the Plan Brochure Matters

The PSHB brochure isn’t just a formality—it’s your best tool to understand cost breakdowns. Every PSHB plan must publish a brochure with exact details on:

• Deductibles

• Copay amounts

• Coinsurance percentages

• Prescription tiers

• Out-of-pocket maximums

• Coordination with Medicare

If you skip this review, you’re making a blind choice based on the surface premium.

Annual Cost Planning Under PSHB

To get a realistic view of your total annual healthcare costs under PSHB in 2025, calculate:

• Your total monthly premium x 12 months

• Any expected deductible

• Typical copays based on frequency of care

• Estimated coinsurance for known procedures or specialists

• Potential prescription costs, especially for non-generics

Adding these gives you a much clearer sense of what you’ll really pay.

How to Choose Smarter in 2025

With the PSHB transition fully in effect, it’s more important than ever to compare your plan options using all cost components:

• Don’t just look at premium.

• Review cost-sharing details.

• Factor in coordination with Medicare if you’re eligible.

• Consider your family’s specific medical needs.

You can change your PSHB plan during the Open Season from November to December each year or during a Qualifying Life Event.

It’s About More Than Premiums—It’s About True Affordability

Choosing the right PSHB plan in 2025 requires more than just comparing premiums. Real affordability depends on how much you’ll pay after the monthly deductions—in deductibles, copays, coinsurance, and uncovered services.

To make sure your plan fits your real budget and health needs, talk to a licensed agent listed on this website who can guide you through the fine print and help match your situation with the best plan option.